Coastal Heart, Inc

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

COASTAL HEART, INC

Doing business as

Coastal Heart Medical Group

Practice address

2621 S Bristol St Ste 108
Santa Ana, CA 92704-5718

Phone

(714) 754-1684

Fax

(714) 966-0417

NPI assigned

Jul 17, 2006

Last updated

May 19, 2020By 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

Rebeca E Hernandez

Title

Administrator

Phone

(714) 754-1684

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 2

• Coastal Heart Medical Group Doing business as
• Coastal Heart Inc Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Guanyin Surgery Center,Inc

  • Ambulatory Surgical Clinic/Center
  • Chino, CA
  • NPI 1154795730

  O20040603001531

  Same enrollment

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

CLIA laboratory certificates

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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.

• Anil Vallabhdas Shah, M.D.

  • Specialist
  • Santa Ana, CA
  • NPI 1619997368
  Medicare reassignment Care Compare group NPD
• Devin Stephen Zarkowsky, MD

  • Vascular Surgery Physician
  • Fallbrook, CA
  • NPI 1689925844
  Medicare reassignment Care Compare group
• George Pisimisis, MD

  • Vascular Surgery Physician
  • Fullerton, CA
  • NPI 1538288311
  Medicare reassignment NPD
• Syed A Samee, MD

  • Cardiovascular Disease Physician
  • Duarte, CA
  • NPI 1548311814
  Medicare reassignment NPD
• Dalia M Zaky Dawoud, MD

  • Nephrology Physician
  • Riverside, CA
  • NPI 1508026386
  Medicare reassignment NPD
• Elaine Peterson, PA

  • Physician Assistant
  • Santa Ana, CA
  • NPI 1992572515
  Medicare reassignment
• Stacey Marie Shoop, M.D.

  • Medical Physician Assistant
  • Santa Ana, CA
  • NPI 1104222124
  Medicare reassignment

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589846400000",
    "number": "1881612828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 S BRISTOL ST",
            "address_2": "SUITE 108",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045718",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 S BRISTOL ST STE 108",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045718",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2621 S Bristol St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927045718",
            "country_code": "US",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11760 Central Ave Ste 204",
            "address_purpose": "LOCATION",
            "city": "Chino",
            "state": "CA",
            "postal_code": "917101909",
            "country_code": "US",
            "telephone_number": "714-754-1684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL HEART, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "REBECA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-754-1684"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Heart Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Heart Inc",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Coastal Heart Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Coast Pain Management Medical Group, Inc.
• Coast@Coast Diagnostics, a Medical Corporation
• Coast2Coast DX
• Coastal Communities Hospital
• Coastal Emergency Physicians a Medical Corporation
• Coastal Radiology
• Coastline Surgery Center Inc.
• Kelly Gene Coburn, LMFT
• Colleen Cochran, BCBA
• Aidan Cockerill

• Cardiovascular Disease Physician in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; 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.