NPIMap

Organization Active NPI

Coastal Prosthetics and Orthotics, LLC

  • Prosthetic/Orthotic Supplier
  • Chesapeake, VA
National Provider Identifier
1164990040
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
COASTAL PROSTHETICS AND ORTHOTICS, LLC
Practice address
433 Network Sta
Chesapeake, VA 23320-3851
Phone
(757) 892-5300
Fax
(757) 892-5303
NPI assigned
Nov 8, 2018
Last updated
Jul 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Authorized official

Name
Karen Vaughn
Title
Administrator
Phone
(757) 828-5112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

433 Network Sta
Chesapeake, VA 23320-3851

Mailing address

433 Network Sta
Chesapeake, VA 23320-3851
Phone (757) 892-5300

Other identifiers 2

IdentifierTypeStateIssuer
0049190414MedicaidVA
009190414MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190830000818 VA DME Supplier - Certified Orth/Pros/PedorthistDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 7618189622 Practice locations: Chesapeake, VA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Coastal Prosthetics and Orthotics433 Network Sta, Chesapeake, VA 23320-3851(757) 892-5300 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Sep 24, 2001

National Provider Directory

National Provider Directory
Tax ID family
Coastal Prosthetics and Orthotics LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1164990040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 NETWORK STA",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203851",
            "telephone_number": "757-892-5300",
            "fax_number": "757-892-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 NETWORK STA",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203851",
            "telephone_number": "757-892-5300",
            "fax_number": "757-892-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PROSTHETICS AND ORTHOTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "757-828-5112"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0049190414",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009190414",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.