NPIMap

Organization Active NPI

Coastal Bend Family Practice, PA

  • Family Medicine Physician
  • Corpus Christi, TX
National Provider Identifier
1376166710
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COASTAL BEND FAMILY PRACTICE, PA
Practice address
600 Elizabeth St
Corpus Christi, TX 78404-2235
Phone
(361) 985-1221
Fax
(361) 985-1295
NPI assigned
May 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Authorized official

Name
Brent Lee Pennington, MDNPI 1205098753
Title
President
Phone
(361) 985-1221

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

600 Elizabeth St
Corpus Christi, TX 78404-2235

Mailing address

PO Box 6696
Corpus Christi, TX 78466-6696
Phone (361) 985-1221

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200909000477 TX Part B Supplier - Clinic/Group Practice 7911325998 Receives reassigned benefits from 4 practitioners
Practice locations: Corpus Christi, TX

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
ClaCorpus Christi, TX, CCN 676303 Skilled nursing facility Adp of the SNF May 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1376166710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6696",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784666696",
            "telephone_number": "361-985-1221",
            "fax_number": "361-985-1295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ELIZABETH ST",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784042235",
            "telephone_number": "361-985-1221",
            "fax_number": "361-985-1295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL BEND FAMILY PRACTICE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-20",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "361-985-1221",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

Verify at the official NPI Registry.