NPIMap

Organization Active NPI

Coastal Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Orange Park, FL
National Provider Identifier
1184440463
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL COMMUNITY HEALTH SERVICES, INC.
Practice address
1605 Kingsley Ave
Orange Park, FL 32073-4435
Phone
(904) 750-3380
NPI assigned
Dec 2, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

Name
Dr. Kavanaugh Chandler, MD
Title
Ceo
Phone
(912) 275-8028

Specialties & licenses 1

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

Addresses

Primary practice location

1605 Kingsley Ave
Orange Park, FL 32073-4435

Mailing address

100 Professional Center Dr
Brunswick, GA 31525-6743
Phone (912) 574-5075

Other names 1

  • Coastal Community Health-Jacksonville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250211002641 FL Part A Provider - Federally Qualified Health Center (FQHC) 0345463683 Practice locations: Orange Park, FL

Federally qualified health center certification: CCN C11045

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Doing business as
COASTAL COMMUNITY HEALTH-JACKSONVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2025
Last certification
Jan 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1605 Kingsley Ave
Orange Park, FL 32073-4435

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
10D2321274Coastal Community Health Services Inc1605 Kingsley Ave, Orange Park, FL 32073Provider-performed microscopyMar 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coastal HLTH Srvcs Inc24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

7855 Argyle Forest Blvd
Ste 303
Jacksonville, FL 32244
Phone (904) 750-3380

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Faye Mathis Individual Corporate DirectorBoard Vice Chair Jan 9, 2020
Kavanaugh Chandler Individual Corporate DirectorCeo Jul 1, 2021 100%
W-2 Managing EmployeeCeo Jul 6, 2021 100%
Jeffery Clark Individual Corporate DirectorBoard Treasurer Aug 17, 2022
Samantha Young Individual Corporate DirectorBoard Member Jun 26, 2023
Josiah Watts Individual Corporate DirectorBoard Chair Aug 30, 2022
D'Jon McNair Individual Corporate DirectorBoard Member May 26, 2023

Practitioners & affiliated clinicians

Practitioners 54

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1184440463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL CENTER DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315256743",
            "telephone_number": "912-574-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734435",
            "telephone_number": "904-750-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL COMMUNITY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-02",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "KAVANAUGH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-275-8028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Community Health-Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.