NPIMap

Organization Active NPI

Coastal Medical & Wellness Center, PLLC

  • Neurology Physician
  • Stuart, FL
National Provider Identifier
1679701064
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME104153 Issued in FL
Legal business name
COASTAL MEDICAL & WELLNESS CENTER, PLLC
Practice address
3257 SE Salerno Rd
Suite 3
Stuart, FL 34997-6736
Phone
(772) 286-5277
Fax
(772) 286-9478
NPI assigned
Jun 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Lynne E Atwell
Title
Office Manager
Phone
(772) 286-5277

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH8186 FL
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X ME104153 FL Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X ARNP9174934 FL

Addresses

Primary practice location

3257 SE Salerno Rd
Suite 3
Stuart, FL 34997-6736

Mailing address

3257 SE Salerno Rd
Suite 3
Stuart, FL 34997-6736
Phone (772) 286-5277

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091202000133 FL Part B Supplier - Clinic/Group Practice 1254470487 Receives reassigned benefits from 3 practitioners
Practice locations: Stuart, FL

National Provider Directory

National Provider Directory

Locations

3257 SE Salerno Rd
Unit 3
Stuart, FL 34997
Phone (772) 286-5277

Practitioners & affiliated clinicians

Practitioners 8

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": "1245801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1679701064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3257 SE SALERNO RD",
            "address_2": "SUITE 3",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349976736",
            "telephone_number": "772-286-5277",
            "fax_number": "772-286-9478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3257 SE SALERNO RD",
            "address_2": "SUITE 3",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349976736",
            "telephone_number": "772-286-5277",
            "fax_number": "772-286-9478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MEDICAL & WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-24",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "ATWELL",
        "authorized_official_first_name": "LYNNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "772-286-5277"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8186",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME104153",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9174934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; 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.