NPIMap

Organization Active NPI

Coastal Pediatric Associates, P.a.

  • Pediatrics Physician
  • Charleston, SC
National Provider Identifier
1770700759
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
COASTAL PEDIATRIC ASSOCIATES, P.A.
Practice address
2067 Charlie Hall Blvd
Charleston, SC 29414-5834
Phone
(843) 573-2535
Fax
(843) 573-2534
NPI assigned
Apr 19, 2007
Last updated
Aug 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
Dr. Robert Andrew Clifford, M.D.NPI 1780659284
Title
Partner
Phone
(843) 573-2535

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Psychologist 103TH0100X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2067 Charlie Hall Blvd
Charleston, SC 29414-5834

Mailing address

4975 Lacross Rd Ste 150
North Charleston, SC 29406-6531

Other practice location 1

2015 2nd Ave Ste 102
Summerville, SC 29486-7889
Phone (843) 737-9465

Other practice location 2

2015 2nd Ave # 103
Summerville, SC 29486-7889
Phone (843) 737-9465

Other practice location 3

2015 2nd Ave Ste 101
Summerville, SC 29486-7889
Phone (843) 737-9465

Other practice location 4

1300 Hospital Dr Ste 320
Mount Pleasant, SC 29464-3217
Phone (843) 737-9494

Other practice location 5

1952 Long Grove Dr Ste 202
Mount Pleasant, SC 29464-7579
Phone (843) 791-2992

Other practice location 6

2051 Charlie Hall Blvd.
Charleston, SC 29414
Phone (843) 573-2535

Other practice location 7

776 Daniel Ellis Dr Ste A
Charleston, SC 29412-3094
Phone (843) 795-8100

Other identifiers 8

IdentifierTypeStateIssuer
PG1066MedicaidSC
GP8228MedicaidSC
GP4716MedicaidSC
GP7882MedicaidSC
GP8203MedicaidSC
GP4680MedicaidSC
GP8229MedicaidSC
GP8237MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210311001646 SC Part B Supplier - Clinic/Group Practice 8426464736 Receives reassigned benefits from 14 practitioners
Practice locations: Charleston, SC; Mount Pleasant, SC; Summerville, SC

National Provider Directory

National Provider Directory
Tax ID family
Coastal Pediatric Associates3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2067 Charlie Hall Blvd
Charleston, SC 29414
Phone (843) 573-2535

776 Daniel Ellis Dr
Ste A
Charleston, SC 29412
Phone (843) 795-8100

1952 Long Grove Dr
Ste 202
Mt Pleasant, SC 29464
Phone (843) 573-2535

4975 Lacross Rd
Ste 150
North Charleston, SC 29406
Phone (843) 573-2535

2015 2nd Ave
Ste 102
Summerville, SC 29486
Phone (843) 737-9465

2015 2nd Ave
Ste 103
Summerville, SC 29486
Phone (843) 737-9464

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1770700759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4975 LACROSS RD STE 150",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294066531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2067 CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145834",
            "telephone_number": "843-573-2535",
            "fax_number": "843-573-2534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 2nd Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294867889",
            "country_code": "US",
            "telephone_number": "843-737-9465",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2015 2nd Ave # 103",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294867889",
            "country_code": "US",
            "telephone_number": "843-737-9465",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2015 2nd Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294867889",
            "country_code": "US",
            "telephone_number": "843-737-9465",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 Hospital Dr Ste 320",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294643217",
            "country_code": "US",
            "telephone_number": "843-737-9494",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1952 Long Grove Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294647579",
            "country_code": "US",
            "telephone_number": "843-791-2992",
            "fax_number": "843-971-2992",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2051 Charlie Hall Blvd.",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "29414",
            "country_code": "US",
            "telephone_number": "843-573-2535",
            "fax_number": "843-573-2534",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "776 Daniel Ellis Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294123094",
            "country_code": "US",
            "telephone_number": "843-795-8100",
            "fax_number": "843-722-3010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL PEDIATRIC ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "CLIFFORD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-573-2535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG1066",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8228",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4716",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7882",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8203",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4680",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8229",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8237",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.