Individual provider Active NPI

Kevin Don Coyle, MB BCH BAO LRCPSI

  • Interventional Pain Medicine Physician
  • Brunswick, GA
National Provider Identifier
1891883765
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
060819 Issued in GA
Practice address
3408 Trout St
Brunswick, GA 31520
Phone
(912) 466-9111
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X LL24087 SC
Pain Medicine (Anesthesiology) Physician 207LP2900X 060819 GA
Interventional Pain Medicine Physician 208VP0014X 2007-01110 NC
Interventional Pain Medicine Physician 208VP0014X 060819 GA Primary

Addresses

Primary practice location

3408 Trout St
Brunswick, GA 31520

Mailing address

5191 First Coast Tech Pkwy
3Rd Floor
Jacksonville, FL 32224-0609
Phone (904) 223-3321

Other practice location 1

1507 Alice Street
Waycross, FL 32034-4530
Phone (912) 590-0973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080625000600 GA Practitioner - AnesthesiologyPractitioner - Interventional Pain Management 3476624040 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Interventional Pain Management
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Consultants in Pain Medicine LLCGroup PAC ID 7911975248, 16 clinicians

Practice addresses (Care Compare)

1218 Alice St
Waycross, GA 31501-4525
Phone (912) 590-0973

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.8 of 100Reported as group
Quality
77.71
Promoting interoperability
95
Improvement activities
40
Cost
65.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
LL24087SCMDPain Medicine (Anesthesiology) Physician
2007-01110NCMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Pain Center, LLC Current Accepting new patients
Coastal Pain Center, LLC Current Accepting new patients
Consultants in Pain Medicine, LLC Pain Medicine CurrentSince Jul 1, 2008 Accepting new patients
Consultants in Pain Medicine, LLC Interventional Pain Medicine CurrentSince Jul 1, 2008 Accepting new patients

Locations

5191 First Coast Tech Pkwy
Fl 3
Jacksonville, FL 32224
Phone (904) 222-3332

10475 Centurion Pkwy N
Ste 201
Jacksonville, FL 32256
Phone 90422333213118

3408 Trout St
Brunswick, GA 31520
Phone (912) 267-9000

3221 Glynn Ave
Brunswick, GA 31520
Phone (912) 466-9111

1218 Alice St
Waycross, GA 31501
Phone (912) 264-9029

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1891883765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY",
            "address_2": "3RD FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240609",
            "telephone_number": "904-223-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 TROUT ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "31520",
            "telephone_number": "912-466-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1507 Alice Street",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "FL",
            "postal_code": "320344530",
            "country_code": "US",
            "telephone_number": "912-590-0973",
            "fax_number": "912-590-0180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COYLE",
        "first_name": "KEVIN",
        "middle_name": "DON",
        "name_prefix": "Dr.",
        "credential": "MB BCH BAO LRCPSI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "SC",
            "license": "LL24087",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "060819",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NC",
            "license": "2007-01110",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "060819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

Verify at the official NPI Registry.