NPIMap

Organization Active NPI

Coastal Bend Ambulatory Surgical Center Inc.

  • Ambulatory Surgical Clinic/Center
  • Corpus Christi, TX
National Provider Identifier
1689695959
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
000147 Issued in TX
Legal business name
COASTAL BEND AMBULATORY SURGICAL CENTER INC.
Practice address
900 Morgan Ave
Corpus Christi, TX 78404-2028
Phone
(361) 888-4288
Fax
(361) 888-4786
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Authorized official

Name
Jacob Jackson Moore, MDNPI 1144249277
Title
President/Medical Director
Phone
(361) 888-4288

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
Ambulatory Surgical Clinic/Center 261QA1903X 000147 TX Primary

Addresses

Primary practice location

900 Morgan Ave
Corpus Christi, TX 78404-2028

Mailing address

PO Box 3827
Corpus Christi, TX 78463-3827
Phone (361) 888-4288

Other identifiers 3

IdentifierTypeStateIssuer
HH1251OtherTNBLUE CROSS/BLUE SHIELD
085872201MedicaidTX
490000435OtherTXMEDICARE- RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101122000599 TX Part B Supplier - Ambulatory Surgical Center 9931395514 Practice locations: Corpus Christi, TX

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Coastal Bend Ambulatory Surgical CenterCCN 45C0001040
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

900 Morgan Ave
Corpus Christi, TX 78404
Phone (361) 888-4288

Practitioners & affiliated clinicians

Practitioners 12

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": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1689695959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3827",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784633827",
            "telephone_number": "361-888-4288",
            "fax_number": "361-888-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MORGAN AVE",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784042028",
            "telephone_number": "361-888-4288",
            "fax_number": "361-888-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL BEND AMBULATORY SURGICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "JACKSON",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "361-888-4288",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "000147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "HH1251",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085872201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE- RAILROAD",
            "identifier": "490000435",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.