NPIMap

Organization Active NPI

Dermatology Associates of Coastal Carolina, PA

  • Dermatopathology Physician
  • New Bern, NC
National Provider Identifier
1619903176
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
Legal business name
DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA, PA
Practice address
2115 Neuse Blvd
New Bern, NC 28560-4309
Phone
(252) 633-4461
Fax
(252) 633-6016
NPI assigned
Jun 24, 2006
Last updated
Sep 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Dr. James M Polo, M.D.NPI 1093731168
Title
Medical Director/Owner
Phone
(252) 633-4461

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
Dermatopathology Physician 207ND0900X NU Primary

Addresses

Primary practice location

2115 Neuse Blvd
New Bern, NC 28560-4309

Mailing address

PO Box 890283
Charlotte, NC 28289-0283
Phone (252) 633-4461

Other identifiers 2

IdentifierTypeStateIssuer
017RMOtherNCBCBS GROUP PROVIDER NUMBE
DF3377OtherNCRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060828000107 NC Part B Supplier - Clinic/Group Practice 1658375092 Receives reassigned benefits from 20 practitioners
3 other NPIs on this enrollment
Practice locations: Jacksonville, NC; Kinston, NC; Morehead City, NC; New Bern, NC

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1028808Dermatology Associates of Coastal Carolina2115 Neuse Boulevard, New Bern, NC 28560ComplianceJan 10, 2028

National Provider Directory

National Provider Directory

Locations

2145 Country Club Rd
Ste 100
Jacksonville, NC 28546
Phone (910) 333-9337

3332 Bridges St
Ste 3B
Morehead City, NC 28557

2115 Neuse Blvd
New Bern, NC 28560
Phone (252) 633-4461

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1619903176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890283",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282890283",
            "telephone_number": "252-633-4461",
            "fax_number": "252-633-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 NEUSE BLVD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285604309",
            "telephone_number": "252-633-4461",
            "fax_number": "252-633-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "POLO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "252-633-4461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP PROVIDER NUMBE",
            "identifier": "017RM",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DF3377",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.