Coastal Southeastern Family Practice, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5005148 Issued in NC

Legal business name

COASTAL SOUTHEASTERN FAMILY PRACTICE, PLLC

Practice address

205 W 3Rd St
Pembroke, NC 28372-8768

Phone

(910) 521-0099

Fax

(910) 521-0088

NPI assigned

May 11, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Katara S Chavis, FNPNPI 1245532423

Title

President

Phone

(910) 521-0099

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3128/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Katara S Chavis, FNP-C

  • Family Nurse Practitioner
  • Pembroke, NC
  • NPI 1245532423
  Medicare reassignment NPD Authorized official
• Joseph Earl Roberts Jr., M.D.

  • Family Medicine Physician
  • Lumberton, NC
  • NPI 1518955269
  NPD (past)

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1699067488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W 3RD ST",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728768",
            "telephone_number": "910-521-0099",
            "fax_number": "910-521-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W 3RD ST",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728768",
            "telephone_number": "910-521-0099",
            "fax_number": "910-521-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SOUTHEASTERN FAMILY PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "CHAVIS",
        "authorized_official_first_name": "KATARA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-521-0099",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Madison Montrel Clark, FNP
• Collins & Sampson DDS PA
• Benjamin K Collins
• Jeff Collins, D.D.S.
• Tyler Jeffrey Collins, DDS
• Comfort Care Services, LLC

• Family Nurse Practitioner in Pembroke, NC
• Providers in Pembroke, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; 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.