NPIMap

Coastal Carolina Health Care PA

Organization Active NPI Sleep Medicine (Internal Medicine) Physician · New Bern, NC

NPI 1376582965 · NPPES record last updated Feb 1, 2024

Key facts

NPI
1376582965
Entity type
Organization (NPI type 2)
Primary specialty
Sleep Medicine (Internal Medicine) Physician 207RS0012X
Legal business name
COASTAL CAROLINA HEALTH CARE PA
Practice address
1020 Medical Park Ave
New Bern, NC 28562-0000
Phone
(252) 634-2240
Fax
(252) 634-2241
NPI assigned
Jun 6, 2006
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 18

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

Practitioners 8

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207RS0012X Yes
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

  • CCHC Sleep Lab Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 1, 2024.

{
    "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

All providers in New Bern, NC · Sleep Medicine (Internal Medicine) Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.