NPIMap

Organization Active NPI

Coastal Family Health Center, Inc.

Doing business as Coastal Famil Health Center, D'Iberville Clinic

  • Federally Qualified Health Center (FQHC)
  • D'Iberville, MS
National Provider Identifier
1629309117
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER, INC.
Doing business as
Coastal Famil Health Center, D'Iberville Clinic
Practice address
3446 Popps Ferry Rd
Diberville, MS 39540-2421
Phone
(228) 374-2494
NPI assigned
Jan 22, 2010
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Mr. Angelique S Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

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

Addresses

Primary practice location

3446 Popps Ferry Rd
Diberville, MS 39540-2421

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other names 1

  • Coastal Famil Health Center, D'Iberville Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…
O20100310000407 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: D'Iberville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629309117. Details of each certification follow.

Federally qualified health center certification: CCN 251002

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER-DIBERVILLE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2010
Last certification
Mar 10, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
3446 Popps Ferry Road
D'Iberville, MS 39540-2421

Other NPIs on the same Medicare enrollment 37

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

View all 37

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
25D2007714Coastal Family Health Center Diberville Clinic3446 Popps Ferry Rd, Diberville, MS 39540Provider-performed microscopyMay 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health C54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Judy a Grant Individual Corporate Officer Oct 27, 2014
Xuan Phan Individual Corporate Director Jan 1, 2021
Kwantrell D Green Individual Corporate OfficerPresident Mar 1, 2010
Roy a Tolbert Individual Corporate Officer Oct 27, 2014
Bertha J Oatis Individual Corporate Officer Mar 1, 2010
Paulette T Briscoe Individual Corporate Officer Oct 27, 2014
Christine M McLeod Individual Corporate Officer Oct 27, 2014
Angelique S Greer Individual Corporate OfficerCeo May 21, 2014
W-2 Managing EmployeeCeo May 21, 2014
Xenia G Wickline Individual Corporate Director Jan 1, 2021
Jane Campbell Individual Corporate Director Jan 1, 2021
Donna F Ramirez Individual Corporate OfficerRevenue Cycle Manager May 7, 2012
W-2 Managing EmployeeRevenue Cycle Manager May 7, 2012
Shelby Ward Individual Corporate Director Jan 1, 2021
Joseph P Hudson Individual Corporate Officer Oct 27, 2014

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Practitioners & affiliated clinicians

Practitioners 7

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": "1264118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1629309117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3446 POPPS FERRY RD",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395402421",
            "telephone_number": "228-374-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-22",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Famil Health Center, D'Iberville Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Famil Health Center, D'Iberville Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in D'Iberville, MS

Sources for this page

Verify at the official NPI Registry.