NPIMap

Organization Active NPI

Emerald Coast Urgent Care LLC

  • Urgent Care Clinic/Center
  • Destin, FL
National Provider Identifier
1396865556
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
EMERALD COAST URGENT CARE LLC
Practice address
12598 Highway 98
Suite 101
Destin, FL 32552
Phone
(850) 654-8878
Fax
(850) 654-8840
NPI assigned
Mar 30, 2007
Last updated
Feb 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

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

Authorized official

Name
Dr. Timothy Paul Nichols, M.D.NPI 1720080229
Title
Owner President
Phone
(225) 933-2044

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
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

12598 Highway 98
Suite 101
Destin, FL 32552

Mailing address

4520 Jamestown Ave Ste 3
Baton Rouge, LA 70808-3214
Phone (225) 706-3033

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071030000310 FL Part B Supplier - Clinic/Group Practice 8224125869 Receives reassigned benefits from 17 practitioners
Practice locations: Destin, FL; Inlet Beach, FL; Panama City Beach, FL

National Provider Directory

National Provider Directory

Locations

13625 E Emerald Coast Pkwy
Inlet Beach, FL 32461
Phone (850) 588-1843

12598 US Highway 98 W
Unit 101
Miramar Beach, FL 32550
Phone (850) 654-8878

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1941/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1396865556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 JAMESTOWN AVE STE 3",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708083214",
            "telephone_number": "225-706-3033",
            "fax_number": "225-218-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12598 HIGHWAY 98",
            "address_2": "SUITE 101",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "32552",
            "telephone_number": "850-654-8878",
            "fax_number": "850-654-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST URGENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "225-933-2044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Destin, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; 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.