NPIMap

Organization Active NPI

Crystal Coast Wellness and Performance Center

  • Registered Dietitian
  • Morehead City, NC
National Provider Identifier
1679104293
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
CRYSTAL COAST WELLNESS AND PERFORMANCE CENTER
Practice address
4913 Bridges St Ext Ste 102
Morehead City, NC 28557-8978
Phone
(252) 808-5623
NPI assigned
Feb 1, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

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

Authorized official

Name
Jayme Limbaugh, LDNNPI 1699336156
Title
President
Phone
(252) 808-5623

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
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

4913 Bridges St Ext Ste 102
Morehead City, NC 28557-8978

Mailing address

4913 Bridges St Ext Ste 102
Morehead City, NC 28557-8978
Phone (252) 808-5623

Other identifiers 1

IdentifierTypeStateIssuer
1699336156MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Www.simplepractice.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200611001200 NC Part B Supplier - Clinic/Group Practice 8527489913 Receives reassigned benefits from 6 practitioners
Practice locations: Morehead City, NC
O20250729002706 GA Part B Supplier - Clinic/Group Practice 8527489913 Receives reassigned benefits from 1 practitioner
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory

Locations

140 Johnny Mercer Blvd
Ste 19
Savannah, GA 31410

1117 Cedar Point Blvd
Cedar Point, NC 28584
Phone (252) 808-5623

4913 Bridges St Ext
Ste 102
Morehead City, NC 28557
Phone (252) 648-8010

4913 Bridges St Ext
Bldg B
Morehead City, NC 28557
Phone (252) 808-5623

4913 Bridges St Ext
Morehead City, NC 28557

3232 Wellons Blvd
New Bern, NC 28562

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1580515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1679104293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 BRIDGES ST EXT STE 102",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285578978",
            "telephone_number": "252-808-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 BRIDGES ST EXT STE 102",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285578978",
            "telephone_number": "252-808-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL COAST WELLNESS AND PERFORMANCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-01",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "LIMBAUGH",
        "authorized_official_first_name": "JAYME",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-808-5623",
        "authorized_official_credential": "LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699336156",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.simplepractice.com",
            "affiliation": "N",
            "address_1": "4913 Bridges St Ext Ste 102",
            "city": "Morehead City",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285578978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Morehead City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.