Coastal Kids, a Professional Medical Corporation

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A56395 Issued in CA

Legal business name

COASTAL KIDS, A PROFESSIONAL MEDICAL CORPORATION

Doing business as

Coastal Kids
Coastal Kids, A Professional Medical Corporation

Practice address

2071 San Joaquin Hills Rd
Newport Beach, CA 92660-6505

Phone

(949) 759-1720

Fax

(949) 759-1442

NPI assigned

Mar 8, 2007

Last updated

Nov 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Thompson

Title

Vice President

Phone

(949) 448-8821

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Coastal Kids Doing business as
• Coastal Kids, A Professional Medical Corporation Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 183

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.

• Mussarat Abidi, MD

  • Specialist
  • Ladera Ranch, CA
  • NPI 1053307769
  NPD
• Lamis Al-Ahmad, M.D.

  • Pediatrics Physician
  • Los Angeles, CA
  • NPI 1356445522
  NPD
• Lauren Elizabeth Allen, PA-C

  • Physician Assistant
  • Bakersfield, CA
  • NPI 1932537610
  NPD
• Rebecca Marie Allen, M.D.

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1932441359
  NPD
• Maria Andruzzi Ambrosini, FNP

  • Nurse Practitioner
  • Ladera Ranch, CA
  • NPI 1750898441
  NPD
• Elizabeth Armstrong, CPNP

  • Pediatric Nurse Practitioner
  • Agoura Hills, CA
  • NPI 1518992841
  NPD
• Colleen Marie Bacon, NP

  • Family Nurse Practitioner
  • San Juan Capistrano, CA
  • NPI 1184903270
  NPD
• Lauren Renee Benfanti

  • Physician Assistant
  • Newport Beach, CA
  • NPI 1750048583
  NPD
• Steve Berruecos, DO

  • Pediatrics Physician
  • Bakersfield, CA
  • NPI 1073184354
  NPD
• Michael John Blyth, M.D.

  • Pediatrics Physician
  • Bakersfield, CA
  • NPI 1528463908
  NPD
• John H Carruth, MD

  • Pediatrics Physician
  • San Juan Capistrano, CA
  • NPI 1346337821
  NPD
• Valerie J Cayabyab-Garcia, MD

  • Pediatrics Physician
  • Bakersfield, CA
  • NPI 1518920982
  NPD

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

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    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1740311737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24422 AVENIDA DE LA CARLOTA STE 300",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533628",
            "telephone_number": "949-599-2434",
            "fax_number": "949-599-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2071 SAN JOAQUIN HILLS RD",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926606505",
            "telephone_number": "949-759-1720",
            "fax_number": "949-759-1442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18370 Burbank Blvd Ste 307",
            "address_purpose": "LOCATION",
            "city": "Tarzana",
            "state": "CA",
            "postal_code": "913562850",
            "country_code": "US",
            "telephone_number": "818-996-6000",
            "fax_number": "818-996-4712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24422 Avenida De La Carlota Ste 130",
            "address_purpose": "LOCATION",
            "city": "Laguna Hills",
            "state": "CA",
            "postal_code": "926533618",
            "country_code": "US",
            "telephone_number": "949-951-1376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4968 Booth Cir Ste 106",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926043370",
            "country_code": "US",
            "telephone_number": "949-387-4900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 Corporate Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Ladera Ranch",
            "state": "CA",
            "postal_code": "926942179",
            "country_code": "US",
            "telephone_number": "949-347-7200",
            "country_name": "United States",
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        },
        {
            "address_1": "2920 W Sunset Blvd",
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            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900262128",
            "country_code": "US",
            "telephone_number": "323-825-9223",
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            "country_name": "United States",
            "address_type": "DOM"
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        {
            "address_1": "5448 Franklin Ave Ste 106",
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            "postal_code": "900271614",
            "country_code": "US",
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            "country_name": "United States",
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        {
            "address_1": "3501 S Harbor Blvd",
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            "city": "Santa Ana",
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            "postal_code": "927046919",
            "country_code": "US",
            "telephone_number": "714-929-2300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1230 E Arrow Hwy",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917864910",
            "country_code": "US",
            "telephone_number": "909-622-1235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1920 N Garey Ave",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917672720",
            "country_code": "US",
            "telephone_number": "909-622-1235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9802 Stockdale Hwy Ste 103",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933113653",
            "country_code": "US",
            "telephone_number": "661-663-4444",
            "fax_number": "661-663-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 E Main St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Ventura",
            "state": "CA",
            "postal_code": "930032801",
            "country_code": "US",
            "telephone_number": "805-643-7500",
            "fax_number": "805-643-7510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "29525 Canwood St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Agoura Hills",
            "state": "CA",
            "postal_code": "913014231",
            "country_code": "US",
            "telephone_number": "818-735-5555",
            "fax_number": "818-996-4712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Old River Rd",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933119503",
            "country_code": "US",
            "telephone_number": "661-663-4700",
            "fax_number": "661-663-4740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "114 Pacifica Ste 340",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926183329",
            "country_code": "US",
            "telephone_number": "949-759-1720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1215 34th St",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933012107",
            "country_code": "US",
            "telephone_number": "661-663-4700",
            "fax_number": "661-489-3338",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9508 Stockdale Hwy Ste 150",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933113623",
            "country_code": "US",
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            "fax_number": "661-663-7503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "451 W Gonzales Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Oxnard",
            "state": "CA",
            "postal_code": "930360721",
            "country_code": "US",
            "telephone_number": "805-981-7691",
            "fax_number": "805-981-7676",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25500 Rancho Niguel Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Laguna Niguel",
            "state": "CA",
            "postal_code": "926777373",
            "country_code": "US",
            "telephone_number": "949-448-8821",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "142 W Los Angeles Ave",
            "address_purpose": "LOCATION",
            "city": "Moorpark",
            "state": "CA",
            "postal_code": "930211897",
            "country_code": "US",
            "telephone_number": "805-529-7788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17742 Beach Blvd Ste 240",
            "address_purpose": "LOCATION",
            "city": "Huntington Beach",
            "state": "CA",
            "postal_code": "926476835",
            "country_code": "US",
            "telephone_number": "714-842-0444",
            "fax_number": "714-842-8444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "299 W Hillcrest Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913607820",
            "country_code": "US",
            "telephone_number": "805-497-7888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 La Venta Dr Ste 103",
            "address_purpose": "LOCATION",
            "city": "Westlake Village",
            "state": "CA",
            "postal_code": "913613757",
            "country_code": "US",
            "telephone_number": "805-495-0841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL KIDS, A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "949-448-8821"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A56395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A563950",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Kids",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Kids",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Kids, A Professional Medical Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.