NPIMap

Organization Active NPI

Coastal Internal Medicine, PLLC

  • Physician Assistant
  • Aberdeen, WA
National Provider Identifier
1740528884
Registry record updated Jan 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60328816 Issued in WA
Legal business name
COASTAL INTERNAL MEDICINE, PLLC
Practice address
1921 Sumner Ave
Aberdeen, WA 98520-3606
Phone
(360) 538-0135
Fax
(360) 533-3475
NPI assigned
Jan 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2013

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

Authorized official

Name
Michelle Pelt
Title
Clinic Administrator
Phone
(360) 538-0135

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA60328816 WA Primary

Addresses

Primary practice location

1921 Sumner Ave
Aberdeen, WA 98520-3606

Mailing address

PO Box 87
Aberdeen, WA 98520-0022
Phone (360) 538-0135

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1358985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1740528884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985200022",
            "telephone_number": "360-538-0135",
            "fax_number": "360-533-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 SUMNER AVE",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985203606",
            "telephone_number": "360-538-0135",
            "fax_number": "360-533-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL INTERNAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "PELT",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "360-538-0135"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60328816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.