South Coast Dermatology LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

SOUTH COAST DERMATOLOGY LLC

Practice address

620 Commercial Ave
Coos Bay, OR 97420-1846

Phone

(541) 808-3860

NPI assigned

Jan 15, 2020

Last updated

Jan 15, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Wallace Webster, MDNPI 1528166287

Title

Owner

Phone

(541) 297-5342

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20811/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William Wallace Webster, MD

  • Otolaryngology Physician
  • Coos Bay, OR
  • NPI 1528166287
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1114567377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 COMMERCIAL AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201846",
            "telephone_number": "541-808-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 COMMERCIAL AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201846",
            "telephone_number": "541-808-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "WALLACE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-297-5342",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Soukup, PT, MTC
• South Coast Anesthesia Associates LLC
• South Coast Billing Service
• South Coast Business Employment Corporation
• South Coast Dental Group LLC (South Coast Family Dentistry)
• South Coast Education Service District
• South Coast Hearing Center
• South Coast Hospice & Palliative Care Services Inc (South Coast Hospice Inc)
• South Coast Orthopaedic Associates, PC
• South Coast Radiologists (South Coast Radiology)

• Adult Health Nurse Practitioner in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.