NPIMap

Organization Active NPI

Coastal Carolina Neuropsychiatric Center, PA

  • Psychiatry Physician
  • Jacksonville, NC
National Provider Identifier
1184737462
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
COASTAL CAROLINA NEUROPSYCHIATRIC CENTER, PA
Practice address
200 Tarpon Trail
Jacksonville, NC 28546-5266
Phone
(910) 938-1114
Fax
(910) 938-1118
NPI assigned
Aug 17, 2006
Last updated
Aug 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Authorized official

Name
Carla Mikhail
Title
Practice Administrator
Phone
(910) 938-1114

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Psychologist 103T00000X NU
Family Medicine Physician 207Q00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Neurology Physician 2084N0400X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

200 Tarpon Trail
Jacksonville, NC 28546-5266

Mailing address

200 Tarpon Trail
Jacksonville, NC 28546-5266
Phone (910) 938-1114

Other practice location 1

1200 Fairmont Ct
Fayetteville, NC 28304-4403
Phone (910) 938-1114

Other practice location 2

302 Penny Ln
Morehead City, NC 28557-4306
Phone (910) 938-1114

Other practice location 3

1630 Military Cutoff Rd Ste 108
Wilmington, NC 28403-5719
Phone (910) 938-1114

Other practice location 4

400 Liberty Hill Rd
Lumberton, NC 28358-2446
Phone (910) 938-1114

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061205000123 NC Part B Supplier - Clinic/Group Practice 5890794689 Receives reassigned benefits from 57 practitioners
Practice locations: Wilmington, NC; Fayetteville, NC; Morehead City, NC; Jacksonville, NC; Erwin, NC; Lumberton, NC

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
34D2033043Coastal Carolina Neuropsychiatric Center302 Penny Lane, Morehead City, NC 28557Certificate of waiverNov 21, 2027
34D2183989Coastal Carolina Neuropsychiatric Center1630 Military Cutoff Rd, Suite 108, Wilmington, NC 28403Certificate of waiverMay 12, 2028

National Provider Directory

National Provider Directory

Locations

1200 Fairmont Ct
Fayetteville, NC 28304
Phone (910) 429-1114

117 Beasley St
Kenansville, NC 28349
Phone (910) 296-1851

1630 Military Cutoff Rd
Ste 108
Wilmington, NC 28403

Practitioners & affiliated clinicians

Practitioners 68

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.

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1184737462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TARPON TRAIL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465266",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TARPON TRAIL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465266",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Fairmont Ct",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283044403",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "302 Penny Ln",
            "address_purpose": "LOCATION",
            "city": "Morehead City",
            "state": "NC",
            "postal_code": "285574306",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1630 Military Cutoff Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284035719",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Liberty Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283582446",
            "country_code": "US",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL CAROLINA NEUROPSYCHIATRIC CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "MIKHAIL",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-938-1114"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; 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.