Coastal Carolina ENT, DO, PA

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

DO 1480 Issued in SC

Legal business name

COASTAL CAROLINA ENT, DO, PA

Practice address

3806 Sawtell Rd
Little River, SC 29566-7873

Phone

(843) 663-9090

Fax

(843) 663-9091

NPI assigned

Dec 6, 2012

Last updated

Jun 17, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

COASTAL CAROLINA ENT, DO, PAAs reported in NPPES

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

Authorized official

Name

Ms. Wendy C. Paris, CPC

Title

Insurance/Billing Specialist

Phone

(910) 914-0540

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Coastal Carolina ENT DO PA

  • Otolaryngology/Facial Plastic Surgery Physician
  • Whiteville, NC
  • NPI 1689757007

  8325082498

  Same PAC ID

Tax ID family

Coastal Carolina ENT DO PA3 organizations share this tax ID, including this one

Part of

Coastal Carolina ENT DO PA

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Coastal Carolina ENT

  • Otolaryngology Physician
  • Little River, SC
  • NPI 1760226419
  NPD tax ID
• Coastal Carolina ENT DO PA

  • Otolaryngology/Facial Plastic Surgery Physician
  • Whiteville, NC
  • NPI 1689757007
  NPD tax ID

Locations

Practitioners 7

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.

• Michael D Peters, M.D.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Little River, SC
  • NPI 1194775429
  Medicare reassignment NPD
• Jeffrey Gerard Coury, DO

  • Facial Plastic Surgery Physician
  • Whiteville, NC
  • NPI 1740312487

  SC

  Medicare reassignment NPD
• James Dimuzio Jr., DO

  • Facial Plastic Surgery Physician
  • Whiteville, NC
  • NPI 1306822424

  SC

  Medicare reassignment NPD
• Matthew James Brennan, DO

  • Otolaryngology Physician
  • Philadelphia, PA
  • NPI 1629572086
  NPD
• Erik L Kenyon, DO

  • Facial Plastic Surgery Physician
  • Whiteville, NC
  • NPI 1033195144
  NPD
• Jayna Patel, D.O.

  • Facial Plastic Surgery Physician
  • Evanston, IL
  • NPI 1619109154
  NPD
• Savannah Parker Ward, FNP

  • Family Nurse Practitioner
  • Supply, NC
  • NPI 1336856285
  NPD

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1386989028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 LIBERTY ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723714",
            "telephone_number": "910-914-0540",
            "fax_number": "910-914-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3806 SAWTELL RD",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295667873",
            "telephone_number": "843-663-9090",
            "fax_number": "843-663-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA ENT, DO, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL CAROLINA ENT, DO, PA",
        "enumeration_date": "2012-12-06",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "PARIS",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "INSURANCE/BILLING SPECIALIST",
        "authorized_official_telephone_number": "910-914-0540",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "SC",
            "license": "DO 1480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felicia Clemens, LMT
• Clemson Sports Medicine and Rehabilitation (Myrtle Beach Physical Therapy)
• Clemson Sports Medicine and Rehabilitation (Myrtle Beach Physical Therapy)
• Clemson Sports Medicine and Rehabilitation, Inc (Strand Neurological Therapy)
• Coastal Carolina ENT
• Coastal Chiropractic Care LLC
• Coastal Cosmetic Dental Associates,
• Coastal Eye Group, PC
• Coastal Hearing Centers, Inc
• Coastal Pain Care

• Facial Plastic Surgery Physician in Little River, SC
• Providers in Little River, SC by specialty
• Facial Plastic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.