Coastal Dermatology Institute LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

COASTAL DERMATOLOGY INSTITUTE LLC

Practice address

199 Village Center Blvd Ste 200
Myrtle Beach, SC 29579-3589

Phone

(843) 738-0500

NPI assigned

Oct 19, 2020

Last updated

Jun 2, 2021By 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

Michael Centilli, DONPI 1215223326

Title

Owner

Phone

(517) 203-6532

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Michael Robert Centilli, D.O.

  • Dermatology Physician
  • Myrtle Beach, SC
  • NPI 1215223326

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Matthew Janowicz

  • Physician Assistant
  • Myrtle Beach, SC
  • NPI 1558735878
  Medicare reassignment Care Compare group
• Lindsay Marie Johnson, PA

  • Medical Physician Assistant
  • Myrtle Beach, SC
  • NPI 1972988590
  Medicare reassignment Care Compare group
• Jenna Rojek Talpas, PA-C

  • Physician Assistant
  • Myrtle Beach, SC
  • NPI 1710740204
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1174122444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 VILLAGE CENTER BLVD STE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 VILLAGE CENTER BLVD STE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793589",
            "telephone_number": "843-738-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL DERMATOLOGY INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-19",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "CENTILLI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-203-6532",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Coastal Carolina Primary Care, LLC
• Coastal Center for Cognitive Therapy, PA
• Coastal DME LLC
• Coastal Eye Associates
• Coastal Eye Group, P.C.
• Coastal Eye Group, P.C.
• Coastal Grand Eye Associates LTD. Co.

• MOHS-Micrographic Surgery Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• MOHS-Micrographic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.