NPIMap

Organization Active NPI

Coastal Carolina Health Care PA

Doing business as CCHC Sleep Lab

  • Sleep Medicine (Internal Medicine) Physician
  • New Bern, NC
National Provider Identifier
1376582965
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
Legal business name
COASTAL CAROLINA HEALTH CARE PA
Doing business as
CCHC Sleep Lab
Practice address
1020 Medical Park Ave
New Bern, NC 28562-0000
Phone
(252) 634-2240
Fax
(252) 634-2241
NPI assigned
Jun 6, 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
Mr. Stephen Nuckolls
Title
Ceo
Phone
(252) 514-6685

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RS0012X Primary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X

Addresses

Primary practice location

1020 Medical Park Ave
New Bern, NC 28562-0000

Mailing address

1020 Medical Park Ave
New Bern, NC 28562-5248
Phone (252) 634-2240

Other names 1

  • CCHC Sleep Lab 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

National Provider Directory

National Provider Directory

Locations

1010 Medical Park Ave
New Bern, NC 28562
Phone (252) 636-5135

Practitioners & affiliated clinicians

Practitioners 8

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": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1376582965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 MEDICAL PARK AVE",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625248",
            "telephone_number": "252-634-2240",
            "fax_number": "252-634-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MEDICAL PARK AVE",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285620000",
            "telephone_number": "252-634-2240",
            "fax_number": "252-634-2241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA HEALTH CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCHC Sleep Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCHC Sleep Lab",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.