NPIMap

Organization Active NPI

Coastal Carolina Health Care, PA

Doing business as CCHC Craven Podiatry

  • Foot & Ankle Surgery Podiatrist
  • New Bern, NC
National Provider Identifier
1184278335
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
COASTAL CAROLINA HEALTH CARE, PA
Doing business as
CCHC Craven Podiatry
CCHC Podiatry
Practice address
800 Medical Park Ave
New Bern, NC 28562
Phone
(252) 637-3988
NPI assigned
Jul 26, 2019
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
Stephen Nuckolls
Title
Ceo
Phone
(252) 514-6685

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

800 Medical Park Ave
New Bern, NC 28562

Mailing address

PO Box 12248
New Bern, NC 28561-2248
Phone (252) 514-6685

Other names 2

  • CCHC Craven Podiatry Doing business as
  • CCHC Podiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031230000224 NC Part B Supplier - Clinic/Group Practice 9739087693 Receives reassigned benefits from 137 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Bern, NC; Morehead City, NC; Havelock, NC; Bayboro, NC
O20191009002496 NC DME Supplier - Physician - Podiatry 9739087693 Practice locations: New Bern, NC

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Coastal Carolina Health PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1184278335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12248",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285612248",
            "telephone_number": "252-514-6685",
            "fax_number": "252-514-2745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MEDICAL PARK AVE",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "28562",
            "telephone_number": "252-637-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA HEALTH CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "NUCKOLLS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-514-6685"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCHC Craven Podiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCHC Craven Podiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCHC Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.