House Calls of Coastal Georgia, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

15631

Legal business name

HOUSE CALLS OF COASTAL GEORGIA, PC

Practice address

811 Sand Dollar Trce
St Simons Island, GA 31522-3761

Phone

(912) 580-6913

Fax

(912) 265-2859

NPI assigned

Jan 21, 2013

Organization subpart

No

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

Authorized official

Name

Ismael Salim Osta, PA-C

Title

Manager

Phone

(912) 581-6913

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1358726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1134467533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SAND DOLLAR TRCE",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315223761",
            "telephone_number": "912-580-6913",
            "fax_number": "912-265-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SAND DOLLAR TRCE",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315223761",
            "telephone_number": "912-580-6913",
            "fax_number": "912-265-2859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSE CALLS OF COASTAL GEORGIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-21",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "OSTA",
        "authorized_official_first_name": "ISMAEL",
        "authorized_official_middle_name": "SALIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-581-6913",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": "15631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021787368C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00069297A3",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in St Simons Island, GA
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.