NPIMap

Organization Active NPI

Coastal Vascular Institute, PA

  • Vascular Surgery Physician
  • Wilmington, NC
National Provider Identifier
1578656773
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
CERTIFICATE # 40958 Issued in NC
Legal business name
COASTAL VASCULAR INSTITUTE, PA
Practice address
1411 Physicians Drive
Wilmington, NC 28401-7338
Phone
(910) 343-0811
Fax
(910) 343-5719
NPI assigned
Oct 2, 2006
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Kara Florence Marcussen
Title
Ceo
Phone
(910) 343-0811

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X CERTIFICATE # 40958 NC
Surgery Physician 208600000X 40958 NC
Vascular Surgery Physician 2086S0129X 40958 NC
Vascular Surgery Physician 2086S0129X CERTIFICATE # 40958 NC Primary

Addresses

Primary practice location

1411 Physicians Drive
Wilmington, NC 28401-7338

Mailing address

1411 Physicians Drive
Wilmington, NC 28401-7338
Phone (910) 343-0811

Other identifiers 5

IdentifierTypeStateIssuer
142384OtherNCGRP UNITED HEALTHCARE #
CB0557OtherNCRAILROAD MEDICARE GROUP #
0271COtherNCBCBS OF NC
0271COtherNCBCBS OF NC GROUP #
79-0271CMedicaidNC

Other names 1

  • Coastal Carolina Surgical Associates, PA Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040716001068 NC Part B Supplier - Clinic/Group Practice 4486633005 Receives reassigned benefits from 10 practitioners
Practice locations: Wilmington, NC
O20170918003811 NC DME Supplier - Physician - General Practice 4486633005 Practice locations: Wilmington, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1578656773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 PHYSICIANS DRIVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "910-343-0811",
            "fax_number": "910-343-5719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 PHYSICIANS DRIVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "910-343-0811",
            "fax_number": "910-343-5719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL VASCULAR INSTITUTE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "MARCUSSEN",
        "authorized_official_first_name": "KARA",
        "authorized_official_middle_name": "FLORENCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-343-0811"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "CERTIFICATE # 40958",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "40958",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NC",
            "license": "40958",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NC",
            "license": "CERTIFICATE # 40958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP UNITED HEALTHCARE #",
            "identifier": "142384",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CB0557",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "0271C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC GROUP #",
            "identifier": "0271C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "79-0271C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Carolina Surgical Associates, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.