Coastal Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

COASTAL SURGICAL CENTER, LLC

Practice address

291 Shattuck Way
Newington, NH 03801

Phone

(561) 330-3381

Fax

(561) 330-3382

NPI assigned

May 18, 2021

Organization subpart

No

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

Authorized official

Name

Mr. N. Timothy Peters, MD

Title

Medical Director, Member

Phone

(603) 969-9297

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

Listed as

Coastal Surgical Center LLCCCN 30C0001049

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

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

• Jennifer Jing Ling, M.D.

  • Ophthalmology Physician
  • Portsmouth, NH
  • NPI 1366860025
  NPD (past)
• Nathaniel C Sears

  • Ophthalmology Physician
  • Portsmouth, NH
  • NPI 1306103577
  NPD (past)
• Timothy W Sullivan, MD

  • Ophthalmology Physician
  • Portsmouth, NH
  • NPI 1538486717
  NPD (past)

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

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1336713890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 BORTHWICK AVENUE",
            "address_2": "SUITE 200 E",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "03801",
            "telephone_number": "561-330-3381",
            "fax_number": "561-330-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 SHATTUCK WAY",
            "city": "NEWINGTON",
            "state": "NH",
            "postal_code": "03801",
            "telephone_number": "561-330-3381",
            "fax_number": "561-330-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-18",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "N.",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR, MEMBER",
        "authorized_official_telephone_number": "603-969-9297",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabelle Cerundolo, OTR
• Jack Chan, MD
• Nicole Chetsas
• CJ Physical Therapy and Wellness, LLC
• Christine Clarke-Swift
• Erin E Conlan, MS ED, BCBA
• Amy M Coombs, ARNP
• Jenna Dalton
• Melanie Theresa Deflumeri, BCBA
• Carla Ann Desrosiers, RPH

• Ambulatory Surgical Clinic/Center in Newington, NH
• Providers in Newington, NH by specialty
• Ambulatory Surgical Clinic/Center in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.