NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

  • Pulmonary Disease Physician
  • Wilmington, NC
National Provider Identifier
1730769340
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Practice address
1090 Medical Center Dr
Wilmington, NC 28401-7353
Phone
(910) 662-8550
Fax
(910) 343-1924
NPI assigned
Apr 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Authorized official

Name
Shala Davis
Title
RCS Manager
Phone
(704) 303-7517

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

1090 Medical Center Dr
Wilmington, NC 28401-7353

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

1333 S Dickinson Dr Unit 230
Leland, NC 28451-6434
Phone (910) 662-8550

Other practice location 2

1415 Physicians Dr
Wilmington, NC 28401-7338
Phone (910) 662-8550

Other names 2

  • Coastal Pulmonary Medicine Doing business as
  • Novant Health Pulmonary Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408000285 NC Part B Supplier - Clinic/Group Practice 2860809936 Receives reassigned benefits from 798 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

National Provider Directory

National Provider Directory

Locations

1333 S Dickinson Dr
Unit 140
Leland, NC 28451
Phone (910) 662-6600

512 Village Rd
Ste 101
Shallotte, NC 28470
Phone (910) 721-4390

1960 S 16th St
Ste 1
Wilmington, NC 28401
Phone (910) 662-6000

Practitioners 4

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": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1730769340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017353",
            "telephone_number": "910-662-8550",
            "fax_number": "910-343-1924"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 S Dickinson Dr Unit 230",
            "address_purpose": "LOCATION",
            "city": "Leland",
            "state": "NC",
            "postal_code": "284516434",
            "country_code": "US",
            "telephone_number": "910-662-8550",
            "fax_number": "910-343-1924",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1415 Physicians Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017338",
            "country_code": "US",
            "telephone_number": "910-662-8550",
            "fax_number": "910-343-1924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-303-7517"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Pulmonary Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Pulmonary Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Pulmonary Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.