Coastal Digestive Care Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0303 Issued in CT

Legal business name

COASTAL DIGESTIVE CARE CENTER LLC

Practice address

234A Bank St
4TH Floor
New London, CT 06320

Phone

(860) 447-0402

Fax

(860) 447-8117

NPI assigned

Jul 7, 2006

Last updated

May 7, 2009By 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

John Frese Jr., MDNPI 1457316382

Title

Medical Director

Phone

(860) 442-0290

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Coastal Digestive Care Center LLCCCN 07C0001035

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 6

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.

• Amzad Khan, M.D.

  • Gastroenterology Physician
  • New London, CT
  • NPI 1790945996
  Medicare reassignment NPD
• John Frese, M.D.

  • Gastroenterology Physician
  • New London, CT
  • NPI 1457316382
  NPD (past) Authorized official
• Mical S Campbell, MD

  • Gastroenterology Physician
  • New London, CT
  • NPI 1083628770
  NPD (past)
• Teresa L D'Errico, APRN

  • Nurse Practitioner
  • New London, CT
  • NPI 1356384556
  NPD (past)
• Darrick K Li, MD, PHD

  • Gastroenterology Physician
  • New Haven, CT
  • NPI 1063825131
  NPD (past)
• Eugene Sapozhnikov, M.D.

  • Gastroenterology Physician
  • New London, CT
  • NPI 1164488094
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241654400000",
    "number": "1811929300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234A BANK ST",
            "address_2": "4TH FLOOR",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "06320",
            "telephone_number": "860-447-0402",
            "fax_number": "860-447-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234A BANK ST",
            "address_2": "4TH FLOOR",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "06320",
            "telephone_number": "860-447-0402",
            "fax_number": "860-447-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL DIGESTIVE CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2009-05-07",
        "status": "A",
        "authorized_official_last_name": "FRESE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "860-442-0290",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CT",
            "license": "0303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001284083",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001385617",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004223137",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001168194",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001317975",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of New London
• Christopher Brett Clark, D.M.D.
• Sean Clark, HS1
• Holden E Clauson, D.D.S.
• Coastal Connecticut Research LLC (CCRstudies.com)
• Coastal Digestive Diseases
• Coastal Digestive Diseases PC
• Margo R. Coffey, PA-C
• Stephen Richard Cofone
• Grace Cogan

• Ambulatory Surgical Clinic/Center in New London, CT
• Providers in New London, CT by specialty
• Ambulatory Surgical Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; 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.