NPIMap

Organization Active NPI

Coastal Cardiology, P.a.

  • Cardiovascular Disease Physician
  • Charleston, SC
National Provider Identifier
1881645893
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
COASTAL CARDIOLOGY, P.A.
Practice address
1033 Saint Andrews Blvd
Charleston, SC 29407-7156
Phone
(843) 723-6161
Fax
(843) 723-0675
NPI assigned
May 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

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

Authorized official

Name
Van C. Hendry
Title
Coo
Phone
(843) 377-1804

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1033 Saint Andrews Blvd
Charleston, SC 29407-7156

Mailing address

1033 Saint Andrews Blvd
Charleston, SC 29407-7156
Phone (843) 723-6111

Other identifiers 1

IdentifierTypeStateIssuer
PA9570MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070907000502 SC Part B Supplier - Clinic/Group Practice 1850484783 Receives reassigned benefits from 23 practitioners
Practice locations: Charleston, SC; Summerville, SC; Mt Pleasant, SC; Moncks Corner, SC

National Provider Directory

National Provider Directory

Locations

125 Doughty St
Ste 370
Charleston, SC 29403

2270 Ashley Crossing Dr
#105
Charleston, SC 29414
Phone (843) 571-7758

501 Carnes Crossing Blvd
Summerville, SC 29486

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1881645893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077156",
            "telephone_number": "843-723-6111",
            "fax_number": "843-727-0973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077156",
            "telephone_number": "843-723-6161",
            "fax_number": "843-723-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARDIOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "HENDRY",
        "authorized_official_first_name": "VAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "843-377-1804"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA9570",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.