NPIMap

Organization Active NPI

Coastal Carolina ENT DO PA

  • Otolaryngology/Facial Plastic Surgery Physician
  • Whiteville, NC
National Provider Identifier
1689757007
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
85930 Issued in NC
Legal business name
COASTAL CAROLINA ENT DO PA
Practice address
302 Liberty St
Whiteville, NC 28472-3714
Phone
(910) 914-0540
Fax
(910) 914-0640
NPI assigned
Oct 21, 2006
Last updated
Jun 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Authorized official

Name
Mrs. Wendy Cotrina Paris, CPC
Title
Insurance Billing MGR
Phone
(910) 914-0540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 85930 NC Primary

Addresses

Primary practice location

302 Liberty St
Whiteville, NC 28472-3714

Mailing address

302 Liberty St
Whiteville, NC 28472-3714
Phone (910) 914-0540

Other identifiers 1

IdentifierTypeStateIssuer
89012KNMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050620000466 NC Part B Supplier - Clinic/Group Practice 8325082498 Receives reassigned benefits from 8 practitioners
Practice locations: Whiteville, NC; Supply, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Coastal Carolina ENT DO PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1689757007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 LIBERTY ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723714",
            "telephone_number": "910-914-0540",
            "fax_number": "910-914-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 LIBERTY ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723714",
            "telephone_number": "910-914-0540",
            "fax_number": "910-914-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA ENT DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "PARIS",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "COTRINA",
        "authorized_official_title_or_position": "INSURANCE BILLING MGR",
        "authorized_official_telephone_number": "910-914-0540",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NC",
            "license": "85930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012KN",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.