Rockport Medical Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

673904 Issued in TX

Legal business name

ROCKPORT MEDICAL CLINIC LLC

Doing business as

Coastal Medical Clinic

Practice address

1704 Jenkins St
Rockport, TX 78382-3341

Phone

(361) 790-9047

Fax

(361) 790-9615

NPI assigned

Jan 4, 2008

Last updated

Dec 6, 2022By 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

Mr. Randy D. Bingham, P.A.

Title

Owner Provider

Phone

(361) 790-9047

Specialties & licenses 2

Addresses

Other names 1

• Coastal Medical Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780869065. Details of each certification follow.

• CCN 673904 Rural health clinic · Active · Name & address match · Details

Rural health clinic certification: CCN 673904

Legal name

COASTAL MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 9, 2008

Last certification

Nov 4, 2015

Ownership / control type

1A

Facility address

1704 Jenkins Street
Rockport, TX 78382

Locations

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

{
    "created_epoch": "1199404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1780869065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 JENKINS ST",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783823341",
            "telephone_number": "361-790-9047",
            "fax_number": "361-790-9615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 JENKINS ST",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783823341",
            "telephone_number": "361-790-9047",
            "fax_number": "361-790-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKPORT MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-04",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "BINGHAM",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER  PROVIDER",
        "authorized_official_telephone_number": "361-790-9047",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "673904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rural Health Clinic/Center in Rockport, TX
• Providers in Rockport, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.