NPIMap

Organization Active NPI

Coastal Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Brunswick, GA
National Provider Identifier
1609298751
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL COMMUNITY HEALTH SERVICES INC
Practice address
106 Shoppers Way
Suite 1
Brunswick, GA 31525-0530
Phone
(912) 275-8028
Fax
(912) 289-2085
NPI assigned
Jan 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

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

Authorized official

Name
Barbara Meyers
Title
Director
Phone
(912) 574-5074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

106 Shoppers Way
Suite 1
Brunswick, GA 31525-0530

Mailing address

106 Shoppers Way
Suite 1
Brunswick, GA 31525-0530
Phone (912) 275-8028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20140514000961 GA Part A Provider - Federally Qualified Health Center (FQHC) 0345463683 Practice locations: Brunswick, GA
O20140731001948 GA Part B Supplier - Clinic/Group Practice 0345463683 Receives reassigned benefits from 67 practitioners
3 other NPIs on this enrollment
Practice locations: Waynesville, GA; Woodbine, GA; Townsend, GA; St Simons Island, GA; Savannah, GA; Saint Marys, GA; Pooler, GA; Nahunta, GA…
O20171110000425 GA Part A Provider - Federally Qualified Health Center (FQHC) 0345463683 1 other NPI on this enrollment
Practice locations: Townsend, GA
O20220607003401 GA Part A Provider - Federally Qualified Health Center (FQHC) 0345463683 1 other NPI on this enrollment
Practice locations: Townsend, GA

Federally qualified health center certification: CCN 111981

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 15, 2014
Last certification
May 15, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 2012 in GA
Enrollment address
106 Shoppers Way
Ste 1
Brunswick, GA 31525-0511

Federally qualified health center certification: CCN 111073

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 10, 2017
Last certification
Nov 10, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 2012 in GA
Enrollment address
6574 Shellman Bluff Rd NE
Townsend, GA 31331-4676

Federally qualified health center certification: CCN 851171

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2022
Last certification
May 23, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 2012 in GA
Enrollment address
1299 Ga Highway 57
Townsend, GA 31331-8128

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

106 Shoppers Way
Brunswick, GA 31525
Phone (912) 265-7660

2321 Pooler Pkwy
Ste 106109
Pooler, GA 31322
Phone (912) 303-7149

Interoperability endpoints

  • Direct secure messaging: courtney.kane@cchs.gadirect.net
  • Direct secure messaging: tyler.cole@cchs.gadirect.net
  • Direct secure messaging: windy.meadows@cchs.gadirect.net
  • Direct secure messaging: mandy.poginy@cchs.gadirect.net
  • Direct secure messaging: victoria.hinckley@cchs.gadirect.net
  • Direct secure messaging: ruth.brown@cchs.gadirect.net
  • Direct secure messaging: christie.tolbert@cchs.gadirect.net
  • Direct secure messaging: kendall.benton@cchs.gadirect.net
  • Direct secure messaging: kelli.beard@cchs.gadirect.net
  • Direct secure messaging: shonna.dillman@cchs.gadirect.net
  • Direct secure messaging: roberto.lara@cchs.gadirect.net
  • Direct secure messaging: heath.brown@cchs.gadirect.net
  • Direct secure messaging: ulyssa.middleton@cchs.gadirect.net
  • Direct secure messaging: felicia.jerome@cchs.gadirect.net
  • Direct secure messaging: briana.gray@cchs.gadirect.net
  • Direct secure messaging: terese.truax@cchs.gadirect.net

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jennifer Duvall Individual Corporate DirectorBoard Secretary Dec 24, 2019
Faye Mathis Individual Corporate DirectorBoard Member Jan 9, 2020
Esther Figueroa Individual Corporate DirectorBoard Member Mar 7, 2017
Corporate DirectorBoard Member May 1, 2017
Cheryl Ehrreich Individual Operational/Managerial ControlOffice Manager Feb 24, 2014
Lynn Ventimiglia-Lobit Individual Corporate DirectorBoard Member Jan 24, 2021
Adam Brown Individual Corporate DirectorBoard Chair Jul 1, 2019
Kavanaugh Chandler Individual Corporate DirectorCeo Jul 6, 2021 100%
W-2 Managing EmployeeCeo Jul 6, 2021 100%
Corporate OfficerCeo Aug 1, 2021 100%
W-2 Managing EmployeeCeo Aug 1, 2021 100%
Greg Jaudon Individual Corporate DirectorBoard Treasurer Jul 21, 2015
Corporate DirectorBoard Member Aug 1, 2015
Margaret R Tuten Individual Corporate DirectorBoard Member Oct 16, 2014
Corporate DirectorBoard Member Nov 1, 2014
Stephanie Krause-Jones Individual Corporate DirectorBoard Member May 22, 2014
Corporate DirectorBoard Member May 1, 2014
George Stevens Individual Corporate DirectorBoard Member May 23, 2016
Corporate DirectorBoard Member Apr 1, 2016
John Laws Individual Corporate DirectorBoard Vice Chair Apr 8, 2015
Corporate DirectorBoard Member May 1, 2015
Pamela Rogers Individual Corporate DirectorBoard Member May 22, 2014
Corporate DirectorBoard Member Mar 1, 2013
Polly Andrews-Bean Individual Corporate DirectorBoard Member Apr 1, 2016
Carolyn Tinkham Individual Corporate DirectorBoard Member Mar 1, 2013
Barbara Meyers Individual Corporate OfficerCeo Feb 18, 2014 100%
W-2 Managing EmployeeCeo Feb 18, 2014
Teria Brown Individual Corporate DirectorBoard Member May 1, 2015
Honey Sparre Individual Corporate DirectorBoard Member Dec 27, 2019

Practitioners & affiliated clinicians

Practitioners 104

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

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1389139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1609298751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 SHOPPERS WAY",
            "address_2": "SUITE 1",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250530",
            "telephone_number": "912-275-8028",
            "fax_number": "912-289-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 SHOPPERS WAY",
            "address_2": "SUITE 1",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250530",
            "telephone_number": "912-275-8028",
            "fax_number": "912-289-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-08",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "MEYERS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "912-574-5074"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

Verify at the official NPI Registry.