Coastal Surgical Specialists, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

050000593 Issued in CA

Legal business name

COASTAL SURGICAL SPECIALISTS, INC.

Practice address

921 Oak Park Blvd
101
Pismo Beach, CA 93449-3264

Phone

(805) 473-9850

Fax

(805) 473-9851

NPI assigned

Sep 16, 2006

Organization subpart

No

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

Authorized official

Name

Susan Andersen

Title

Chief Financial Officer

Phone

(805) 739-3110

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Coastal Surgical Specialists IncCCN 05C0001690

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Dignity Health

  dba Dignity Health St. Rose Specialty Clinics

  • Neurological Surgery Physician
  • Henderson, NV
  • NPI 1720358039

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Craig Wesley Canfield, M.D.

  • Urology Physician
  • San Luis Obispo, CA
  • NPI 1053403774
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1821194754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 OAK PARK BLVD",
            "address_2": "101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493264",
            "telephone_number": "805-473-9850",
            "fax_number": "805-473-9851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 OAK PARK BLVD",
            "address_2": "101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493264",
            "telephone_number": "805-473-9850",
            "fax_number": "805-473-9851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SURGICAL SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "805-739-3110"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "050000593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David G. Christensen, M.D.
• Christopher V Lutman MD a California Medical Corporation
• Coastal Podiatry Clinic (Richard J Norman DPM)
• Coastal Podiatry Inc
• Coastal Psychiatry Care Professional Nursing Corp
• Coastal Village Primary Care
• Coastal Village Primary Care, a Medical Group
• Coastal Village Primary, Inc
• Terrell Cohen, D.D.S.
• Kimen M Colgan, PA

• Ambulatory Surgical Clinic/Center in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.