NPIMap

Organization Active NPI

Coastal Pediatrics LLC

  • Pediatrics Physician
  • Summerdale, AL
National Provider Identifier
1689438111
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
COASTAL PEDIATRICS LLC
Practice address
19283 State Highway 59
Summerdale, AL 36580-3005
Phone
(251) 523-5437
NPI assigned
Feb 6, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Authorized official

Name
Peter Strogov, MDNPI 1295964682
Title
Owner
Phone
(251) 523-5437

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

19283 State Highway 59
Summerdale, AL 36580-3005

Mailing address

19283 State Highway 59
Summerdale, AL 36580-3005
Phone (251) 523-5437

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241216000687 AL Part A Provider - Rural Health Clinic 8729514658 Practice locations: Summerdale, AL

Rural health clinic certification: CCN 018985

Legal name
COASTAL PEDIATRICS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 13, 2025
Last certification
Mar 13, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
19283 State Highway 59
Summerdale, AL 36580-3005

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
01D2300790Coastal Pediatrics LLC19283 State Hwy 59, Summerdale, AL 36580Certificate of waiverMar 14, 2028

National Provider Directory

National Provider Directory

Locations

19283 State Highway 59
Summerdale, AL 36580
Phone (251) 523-5437

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Monica M Chadwick Individual 5% Or Greater Direct Ownership Interest Mar 24, 2021 50%
Corporate OfficerMember Mar 24, 2021 50%
Peter Strogov Individual 5% Or Greater Direct Ownership Interest Mar 24, 2021 50%
Corporate Officer Mar 24, 2021 50%
W-2 Managing EmployeePresident Mar 24, 2021 50%

Practitioners & affiliated clinicians

Practitioners 6

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": "1707177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1689438111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19283 STATE HIGHWAY 59",
            "city": "SUMMERDALE",
            "state": "AL",
            "postal_code": "365803005",
            "telephone_number": "251-523-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19283 STATE HIGHWAY 59",
            "city": "SUMMERDALE",
            "state": "AL",
            "postal_code": "365803005",
            "telephone_number": "251-523-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "STROGOV",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-523-5437",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerdale, AL

Sources for this page

Verify at the official NPI Registry.