NPIMap

Organization Active NPI

Coastal Carolina Health Care PA

Doing business as CCHC New Bern Family Practice and CCHC Urgent Care

  • Family Medicine Physician
  • New Bern, NC
National Provider Identifier
1366498297
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COASTAL CAROLINA HEALTH CARE PA
Doing business as
CCHC New Bern Family Practice and CCHC Urgent Care
Practice address
1040 Medical Park Ave
New Bern, NC 28562-5248
Phone
(252) 633-1678
Fax
(252) 633-1403
NPI assigned
May 25, 2006
Last updated
Feb 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Stephen Nuckolls
Title
Ceo
Phone
(252) 514-6685

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1040 Medical Park Ave
New Bern, NC 28562-5248

Mailing address

1040 Medical Park Ave
New Bern, NC 28562-5248
Phone (252) 633-1678

Other names 1

  • CCHC New Bern Family Practice and CCHC Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000224 NC Part B Supplier - Clinic/Group Practice 9739087693 Receives reassigned benefits from 137 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Bern, NC; Morehead City, NC; Havelock, NC; Bayboro, NC

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

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
34D0695765New Bern Family Practice and Urgent Care1040 Medical Park Avenue, New Bern, NC 28562AccreditationMay 12, 2027

National Provider Directory

National Provider Directory

Locations

1224 E Main St
Havelock, NC 28532
Phone (252) 447-7474

511 Penny Ln
Morehead City, NC 28557
Phone (252) 659-4500

1040 Medical Park Ave
New Bern, NC 28562
Phone (252) 633-1678

Practitioners & affiliated clinicians

Practitioners 135

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 135

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1366498297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 MEDICAL PARK AVE",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625248",
            "telephone_number": "252-633-1678",
            "fax_number": "252-633-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MEDICAL PARK AVE",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625248",
            "telephone_number": "252-633-1678",
            "fax_number": "252-633-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA HEALTH CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "NUCKOLLS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-514-6685"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCHC New Bern Family Practice and CCHC Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.