NPIMap

Organization Active NPI

South Coast Orthopaedic Associates, PC

  • Orthopaedic Surgery Physician
  • Coos Bay, OR
National Provider Identifier
1245284751
Registry record updated Dec 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SOUTH COAST ORTHOPAEDIC ASSOCIATES, PC
Practice address
2699 N 17TH St
Coos Bay, OR 97420-2134
Phone
(541) 266-3600
Fax
(541) 269-0708
NPI assigned
May 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2010

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

Authorized official

Name
Christopher T Clarke
Title
Clinic Administrator
Phone
(541) 266-3600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X OR Primary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

2699 N 17TH St
Coos Bay, OR 97420-2134

Mailing address

2699 N 17TH St
Coos Bay, OR 97420-2134
Phone (541) 266-3600

Other identifiers 1

IdentifierTypeStateIssuer
076799MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040423000168 OR Part B Supplier - Clinic/Group Practice 2062408131 Receives reassigned benefits from 14 practitioners
Practice locations: Bandon, OR; Coos Bay, OR

National Provider Directory

National Provider Directory

Locations

780 2nd St SE
Bandon, OR 97411
Phone (541) 266-3600

2699 N 17th St
Ste A
Coos Bay, OR 97420
Phone (541) 266-3600

1740 Thompson Rd
Coos Bay, OR 97420
Phone (541) 266-3658

2645 N 17th St
Coos Bay, OR 97420
Phone (541) 266-3658

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1245284751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2699 N 17TH ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202134",
            "telephone_number": "541-266-3600",
            "fax_number": "541-269-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2699 N 17TH ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202134",
            "telephone_number": "541-266-3600",
            "fax_number": "541-269-0708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST ORTHOPAEDIC ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "541-266-3600"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076799",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2010; 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.