Coastal Senior Healthcare Inc

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

COASTAL SENIOR HEALTHCARE INC

Practice address

3914 E State Road 64
Bradenton, FL 34208-9059

Phone

(941) 216-3800

Fax

(941) 216-3703

NPI assigned

Apr 19, 2017

Last updated

Mar 22, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John K McDermott

Title

President

Phone

(941) 216-3800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16119/brand/1/csg/1/fhir/r4

Practitioners 9

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.

• Brianne Ronelle Foster, APRN

  • Family Nurse Practitioner
  • Bradenton, FL
  • NPI 1891307500
  Medicare reassignment Care Compare group NPD
• Devin Diane Hartley

  • Family Nurse Practitioner
  • Parrish, FL
  • NPI 1740006170
  Medicare reassignment Care Compare group NPD
• Daniel James Johnson, MD

  • Family Medicine Physician
  • Bradenton, FL
  • NPI 1740206549
  Medicare reassignment Care Compare group NPD
• Regina L Soderberg, ARNP

  • Family Nurse Practitioner
  • Bradenton, FL
  • NPI 1508151838
  Medicare reassignment Care Compare group NPD
• Autumn Nicole Stevanus, MSN, APRN, A-GNP-C

  • Adult Health Nurse Practitioner
  • Bradenton, FL
  • NPI 1689139297
  Medicare reassignment Care Compare group NPD
• Krystal Tiffany Young

  • Family Nurse Practitioner
  • Bradenton, FL
  • NPI 1184419921
  Medicare reassignment Care Compare group NPD
• Kerrie Ann Henderson, APRN

  • Family Nurse Practitioner
  • Bradenton, FL
  • NPI 1356694962
  Medicare reassignment Care Compare group
• Catherine I McDermott, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Bradenton, FL
  • NPI 1609838119
  Medicare reassignment NPD
• Diane Lynne Raccio, APRN, ANP-BC

  • Nurse Practitioner
  • Bradenton, FL
  • NPI 1053578377
  Medicare reassignment NPD

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1497289110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3914 E STATE ROAD 64",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342089059",
            "telephone_number": "941-216-3800",
            "fax_number": "941-216-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3914 E STATE ROAD 64",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342089059",
            "telephone_number": "941-216-3800",
            "fax_number": "941-216-3703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8450 Lockwood Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342432920",
            "country_code": "US",
            "telephone_number": "941-216-3800",
            "fax_number": "941-216-3703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL SENIOR HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-216-3800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Cardiovascular Consultants PLLC
• Coastal Orthopedics & Sports Medicine of Southwest FL, PA
• Coastal Orthopedics & Sports Medicine of Southwest Florida PA
• Coastal Orthopedics and Sports Medicine of Southwest Florida P.a. (Coastal Physical Therapy)
• Coastal Practice Management LLC
• Claire Gene Coats, PA-C
• Nathan Jay Coblentz
• Kristie Virginia Cochran, LMHC
• Chris Thomas Cockrell, D.P.T.
• Eileen Grace Codd

• Geriatric Medicine (Family Medicine) Physician in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Geriatric Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.