NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Leakesville, MS
National Provider Identifier
1700979960
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER, INC
Practice address
175 Annex Rd
Leakesville, MS 39451-9602
Phone
(601) 394-5093
Fax
(601) 394-6061
NPI assigned
Oct 2, 2006
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Mrs. Angelique Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

175 Annex Rd
Leakesville, MS 39451-9602

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other identifiers 1

IdentifierTypeStateIssuer
01429351MedicaidMS

Other names 1

  • Coastal Family Health Center, Inc - Annex School Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…
O20170801000579 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Leakesville, MS

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1700979960. Details of each certification follow.

Federally qualified health center certification: CCN 251065

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER, INC - ANNEX SCHOOL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 2017
Last certification
Jul 31, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
175 Annex Rd
Leakesville, MS 37451-9602

Federally qualified health center certification: CCN 251925

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SCHOOL HEALTH SERVICES ANNEX
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2004
Last certification
Jan 15, 2004
Ownership / control type
For profit – corporation
Facility address
175 Annex Road PO Box 160
Leakesville, MS 39451
Related CCNs
251822

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

175 Annex Rd
Leakesville, MS 39451
Phone (601) 394-4507

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Judy a Grant Individual Operational/Managerial ControlBoard Member Dec 31, 2016
Kwantrell D Green Individual Operational/Managerial ControlBoard Member Dec 31, 2016
Roy a Tolbert Individual Operational/Managerial ControlBoard Member Dec 31, 2016
Bertha J Oatis Individual Operational/Managerial ControlBoard Member Dec 31, 2016
Paulette T Briscoe Individual Operational/Managerial ControlBoard Member Dec 31, 2016
Christine M McLeod Individual Operational/Managerial ControlBoard Member Dec 31, 2016
Angelique S Greer Individual Corporate OfficerCeo Dec 31, 2016
Operational/Managerial ControlCeo Dec 31, 2016
Jane Campbell Individual Corporate Director Jan 1, 2021
Donna F Ramirez Individual Operational/Managerial ControlRevenue Cycle Supervisor Dec 31, 2016
Shelby Ward Individual Corporate Director Jan 1, 2021
Joseph P Hudson Individual Operational/Managerial ControlBoard Member Dec 31, 2016

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Practitioners & affiliated clinicians

Practitioners 1

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1700979960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494",
            "fax_number": "228-374-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 ANNEX RD",
            "city": "LEAKESVILLE",
            "state": "MS",
            "postal_code": "394519602",
            "telephone_number": "601-394-5093",
            "fax_number": "601-394-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01429351",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc - Annex School Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Leakesville, MS

Sources for this page

Verify at the official NPI Registry.