NPIMap

Organization Active NPI

Southcoast Physicians Group, Inc.

  • Emergency Medicine Physician
  • Wareham, MA
National Provider Identifier
1619413150
Registry record updated Jan 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SOUTHCOAST PHYSICIANS GROUP, INC.
Practice address
2421 Cranberry Hwy
Wareham, MA 02571-5021
Phone
(508) 973-1816
Fax
(508) 973-1815
NPI assigned
Jan 9, 2017
Last updated
Jan 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2017

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

Authorized official

Name
Kimberley Coon
Title
Director, Medical Staff SVCS
Phone
(508) 973-1816

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MA Primary
Family Medicine Physician 207Q00000X MA
Internal Medicine Physician 207R00000X MA
Pediatrics Physician 208000000X MA
Hospitalist Physician 208M00000X MA

Addresses

Primary practice location

2421 Cranberry Hwy
Wareham, MA 02571-5021

Mailing address

200 Mill Rd
Suite 180
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Other identifiers 4

IdentifierTypeStateIssuer
DT1369OtherRIRAILROAD MEDICARE
BM20689MedicaidRI
CD2506OtherMARAILROAD MEDICARE
110072422AMedicaidMA

Other names 1

  • Southocast Urgent Care Center - Wareham Other name

National Provider Directory

National Provider Directory
Tax ID family
Jennifer S Levy D13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1619413150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "address_2": "SUITE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 CRANBERRY HWY",
            "city": "WAREHAM",
            "state": "MA",
            "postal_code": "025715021",
            "telephone_number": "508-973-1816",
            "fax_number": "508-973-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCOAST PHYSICIANS GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "COON",
        "authorized_official_first_name": "KIMBERLEY",
        "authorized_official_title_or_position": "DIRECTOR, MEDICAL STAFF SVCS",
        "authorized_official_telephone_number": "508-973-1816"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DT1369",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BM20689",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD2506",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110072422A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southocast Urgent Care Center - Wareham",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wareham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.