Coastal Carolina Family Practice PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40834 Issued in NC

Legal business name

COASTAL CAROLINA FAMILY PRACTICE PA

Practice address

600 S Church St
Hertford, NC 27944-1205

Phone

(252) 426-5711

Fax

(252) 426-1999

NPI assigned

Aug 24, 2005

Last updated

Oct 12, 2026By 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

Ms. Devin B Gregory, MBA

Title

Coo

Phone

(252) 426-5711

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

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 11

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.

• Robert Earl Lane, MD

  • Family Medicine Physician
  • Hertford, NC
  • NPI 1023001500
  Medicare reassignment Care Compare group NPD
• Annie T Odom

  • Physician Assistant
  • Greenville, NC
  • NPI 1912723727
  Medicare reassignment Care Compare group NPD
• Amanda Glasenapp

  • Physician Assistant
  • Durham, NC
  • NPI 1992675516
  Medicare reassignment Care Compare group
• Timothy Charles Madigan, M.D.

  • Family Medicine Physician
  • Windsor, NC
  • NPI 1013965060
  Medicare reassignment Care Compare group
• Tessa Jeanne Rayne, PA-C

  • Physician Assistant
  • Hertford, NC
  • NPI 1750111373
  Medicare reassignment Care Compare group
• Amber Eberhart, PA-C

  • Physician Assistant
  • Henderson, NC
  • NPI 1598421869
  Medicare reassignment
• Natalie B Woodard, PA-C

  • Physician Assistant
  • Nags Head, NC
  • NPI 1073536512
  Medicare reassignment
• Dylan B Devries, PA

  • Medical Physician Assistant
  • Pueblo, CO
  • NPI 1770760365

  NC

  Medicare reassignment
• Erik Steven Plantiko, PA-C

  • Physician Assistant
  • Onalaska, WA
  • NPI 1427661966

  NC

  Medicare reassignment
• Meghan Fay Vance, PA-C

  • Physician Assistant
  • Owensboro, KY
  • NPI 1770155566

  NC

  Medicare reassignment
• Beth Neel, PA-C

  • Medical Physician Assistant
  • Hertford, NC
  • NPI 1134557911
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791763200000",
    "number": "1326031485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "HERTFORD",
            "state": "NC",
            "postal_code": "279440650",
            "telephone_number": "252-426-5711",
            "fax_number": "252-426-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S CHURCH ST",
            "city": "HERTFORD",
            "state": "NC",
            "postal_code": "279441205",
            "telephone_number": "252-426-5711",
            "fax_number": "252-426-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA FAMILY PRACTICE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2026-10-12",
        "certification_date": "2026-10-12",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "252-426-5711",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "40834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIGON",
            "identifier": "044647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0222L",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890222L",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather D Baccus
• Bar Enterprises of Perquimans Inc (Russell's Rest Home)
• Jack Lee Boone, DDS
• Bright Outstanding Stars, LLC
• Catholic Charities of the Diocese of Raleigh, Inc
• Connecting Communities NC LLC
• Gabrielle K Corprew
• Natalie Corprew
• County of Perquimans (Perquimans County EMS)
• Haley Pippins Damron, LCMHCA, LCASA

• Family Medicine Physician in Hertford, NC
• Providers in Hertford, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; 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.