NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

Doing business as Coastal Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Bay St Louis, MS
National Provider Identifier
1124016209
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
Coastal Family Health Center
Practice address
109 Hospital Dr
Bay St Louis, MS 39520-1604
Phone
(228) 463-9666
Fax
(228) 374-0856
NPI assigned
Oct 12, 2005
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Mr. Angelique S Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MS Primary

Addresses

Primary practice location

109 Hospital Dr
Bay St Louis, MS 39520-1604

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other names 1

  • Coastal Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…
O20081002000153 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Bay St Louis, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124016209. Details of each certification follow.

Federally qualified health center certification: CCN 251866

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 15, 1998
Last certification
Jul 15, 1998
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
109 Hospital Dr
Bay St Louis, MS 39520-1604

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0948437Coastal Family Health Center-Bay St Louis109 Hospital Drive, Bay St Louis, MS 39520Provider-performed microscopyJun 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health C54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Judy a Grant Individual Corporate DirectorBoard Member Jun 1, 2013
Xuan Phan Individual Corporate Director Jan 1, 2021
Kwantrell D Green Individual Corporate DirectorBoard Member Jun 1, 2009
Roy a Tolbert Individual Corporate DirectorBoard Member Jun 1, 2012
Bertha J Oatis Individual Corporate DirectorBoard Member Jun 1, 2009
Paulette T Briscoe Individual Corporate DirectorBoard Member Jun 1, 2009
Christine M McLeod Individual Corporate Director Jan 1, 2021
Angelique S Greer Individual Corporate OfficerCeo Aug 1, 2010
W-2 Managing Employee Aug 1, 2010
Xenia G Wickline Individual Corporate Director Jan 1, 2021
Jane Campbell Individual Corporate Director Jan 1, 2021
Shelby Ward Individual Corporate Director Jan 1, 2021
Shirley Leist Individual Corporate Director Nov 1, 2021
Joseph P Hudson Individual Corporate DirectorBoard Members Jun 1, 2011

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1124016209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494",
            "fax_number": "228-396-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 HOSPITAL DR",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395201604",
            "telephone_number": "228-463-9666",
            "fax_number": "228-374-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bay St Louis, MS

Sources for this page

Verify at the official NPI Registry.