NPIMap

Organization Active NPI

Coastal Comprehensive Care PA

  • Pain Medicine (Anesthesiology) Physician
  • Whiteville, NC
National Provider Identifier
1861161044
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
COASTAL COMPREHENSIVE CARE PA
Doing business as
Coastal Comprehensive Care PA
Practice address
805 S Madison St
Whiteville, NC 28472-4613
Phone
(910) 663-2273
Fax
(910) 663-4050
NPI assigned
Sep 10, 2021
Last updated
Sep 10, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COASTAL COMPREHENSIVE CARE PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
Alecia RobertsNPI 1750432084
Title
Practice Manager
Phone
(910) 663-2273

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

805 S Madison St
Whiteville, NC 28472-4613

Mailing address

710 Sunset Blvd N Ste a
Sunset Beach, NC 28468-4340
Phone (910) 663-2273

Other names 1

  • Coastal Comprehensive Care PA Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL wecare@cccpa.healthcare Health Information Exchange (HIE) Coastal Comprehensive Care PA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190128002886 NC Part B Supplier - Clinic/Group Practice 9436496536 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hickory, NC; Sunset Beach, NC; Whiteville, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Coastal Comprehensive Care2 organizations share this tax ID, including this one
Part of
Coastal Comprehensive Care

Other organizations with this tax ID 1

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

Locations

1067 13th St SE
Hickory, NC 28602
Phone (828) 358-2090

710 Sunset Blvd N
Ste A
Sunset Beach, NC 28468
Phone (910) 575-3923

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1861161044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 SUNSET BLVD N STE A",
            "city": "SUNSET BEACH",
            "state": "NC",
            "postal_code": "284684340",
            "telephone_number": "910-663-2273",
            "fax_number": "910-663-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 S MADISON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284724613",
            "telephone_number": "910-663-2273",
            "fax_number": "910-663-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL COMPREHENSIVE CARE PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL COMPREHENSIVE CARE PA",
        "enumeration_date": "2021-09-10",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "ALECIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "910-663-2273"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "wecare@cccpa.healthcare",
            "affiliation": "Y",
            "endpointDescription": "Secure Email",
            "affiliationName": "Coastal Comprehensive Care PA",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "710 Sunset Blvd N Ste A",
            "city": "Sunset Beach",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284684340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Coastal Comprehensive Care PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.