NPIMap

Organization Active NPI

Crystal Coast Podiatry, PLLC

  • Podiatrist
  • New Bern, NC
National Provider Identifier
1932265196
Registry record updated Feb 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
417 Issued in NC
Legal business name
CRYSTAL COAST PODIATRY, PLLC
Practice address
3109 Trent Rd
New Bern, NC 28562-5736
Phone
(252) 638-4700
Fax
(252) 638-5766
NPI assigned
Dec 29, 2006
Last updated
Feb 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2010

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

Authorized official

Name
Dr. Thomas John Bobrowski, D.P.M.NPI 1346229671
Title
Managing Member
Phone
(252) 638-4700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 417 NC Primary

Addresses

Primary practice location

3109 Trent Rd
New Bern, NC 28562-5736

Mailing address

3109 Trent Rd
New Bern, NC 28562-5736
Phone (252) 638-4700

Other identifiers 2

IdentifierTypeStateIssuer
0800UOtherNCBCBS
790800UMedicaidNC

National Provider Directory

National Provider Directory

Locations

700 McCarthy Blvd
#A
New Bern, NC 28562
Phone (252) 634-2240

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265760000000",
    "number": "1932265196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 TRENT RD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625736",
            "telephone_number": "252-638-4700",
            "fax_number": "252-638-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 TRENT RD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625736",
            "telephone_number": "252-638-4700",
            "fax_number": "252-638-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL COAST PODIATRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2010-02-10",
        "status": "A",
        "authorized_official_last_name": "BOBROWSKI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "252-638-4700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NC",
            "license": "417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0800U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790800U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.