Coastal Carolina Internal Medicine, PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

200200443 Issued in NC

Legal business name

COASTAL CAROLINA INTERNAL MEDICINE, PA

Practice address

2420 Henderson Dr
Jacksonville, NC 28546-5254

Phone

(910) 937-0008

Fax

(910) 937-0098

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mitzi M Ros, R.N

Title

Office Manager

Phone

(910) 937-0008

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• Jose Larrabaster Ros, M.D

  • Internal Medicine Physician
  • Jacksonville, NC
  • NPI 1356301634
  Medicare reassignment Care Compare group
• Daina E Barber, P.A.-C.

  • Physician Assistant
  • Jacksonville, NC
  • NPI 1255704045
  Care Compare group
• Ceasar R Tria, PA-C

  • Physician Assistant
  • Jacksonville, NC
  • NPI 1841702057
  Care Compare group
• Cynthia Amber Brown, NP-C

  • Family Nurse Practitioner
  • Jacksonville, NC
  • NPI 1477893832
  NPD
• Christina P Rogers, PA

  • Physician Assistant
  • Cary, NC
  • NPI 1144203696
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1881619740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465254",
            "telephone_number": "910-937-0008",
            "fax_number": "910-937-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465254",
            "telephone_number": "910-937-0008",
            "fax_number": "910-937-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA INTERNAL MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "ROS",
        "authorized_official_first_name": "MITZI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-937-0008",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "200200443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8913181",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "13181",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CNC Access Inc
• CNC Access, Inc.
• CNC/Access, Inc.
• Coastal Ambulance Co.,Inc
• Coastal Arthritis and Rheumatism Associates PA
• Coastal Carolina Neuropsychiatric Center, PA
• Coastal Carolina Neuropsychiatric Center, PA
• Coastal Carolina Orthopaedic Surgeons PA
• Coastal Childrens Services PLLC
• Coastal Childrens Services, PLLC

• Primary Care Clinic/Center in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; 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.