NPIMap

Organization Active NPI

Coastal Care MD, LLC

  • Family Medicine Physician
  • Savannah, GA
National Provider Identifier
1881200772
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COASTAL CARE MD, LLC
Practice address
4 Skidaway Village Walk Ste B
Savannah, GA 31411-2962
Phone
(912) 598-6322
NPI assigned
Sep 16, 2020
Last updated
Apr 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Authorized official

Name
Mr. John Scott Pierce
Title
Chief Operating Officer
Phone
(912) 999-1967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4 Skidaway Village Walk Ste B
Savannah, GA 31411-2962

Mailing address

4 Skidaway Village Walk Ste B
Savannah, GA 31411-2962
Phone (912) 598-6322

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201117001583 GA Part B Supplier - Clinic/Group Practice 9436560729 Receives reassigned benefits from 9 practitioners
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory

Locations

7070 Hodgson Memorial Dr
Savannah, GA 31406

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1881200772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SKIDAWAY VILLAGE WALK STE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314112962",
            "telephone_number": "912-598-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SKIDAWAY VILLAGE WALK STE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314112962",
            "telephone_number": "912-598-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARE MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "912-999-1967",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

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