NPIMap

Organization Active NPI

Coastal Family Health Center Inc

Doing business as Coastal Family Health Center, Inc - Saucier Health Center

  • Federally Qualified Health Center (FQHC)
  • Saucier, MS
National Provider Identifier
1942298195
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER INC
Doing business as
Coastal Family Health Center, Inc - Saucier Health Center
Practice address
23453 Central Dr
Saucier, MS 39574-7521
Phone
(228) 832-7223
Fax
(228) 374-0856
NPI assigned
Oct 12, 2005
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Mrs. Angelique Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MS Primary

Addresses

Primary practice location

23453 Central Dr
Saucier, MS 39574-7521

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other identifiers 2

IdentifierTypeStateIssuer
9010021MedicaidMS
C00895OtherMSMEDICARE

Other names 2

  • Coastal Family Health Center, Inc - Saucier Health Center Doing business as
  • Coastal Family Health Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000577 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 1 other NPI on this enrollment
Practice locations: Saucier, MS
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942298195. Details of each certification follow.

Federally qualified health center certification: CCN 251920

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER - SAUCIER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 4, 2003
Last certification
Nov 4, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
23453 Central Dr
Saucier, MS 39574-7521
Related CCNs
251811

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 38

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

View all 38

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0319914Coastal Family Health Center-Saucier Clinic23453 Central Dr, Saucier, MS 39574Provider-performed microscopySep 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health Center54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Judy a Grant Individual Corporate DirectorBoard Member Jun 1, 2013
Xuan Phan Individual Corporate Director Jan 1, 2021
Kwantrell D Green Individual Corporate DirectorBoard Member Jun 1, 2009
Roy a Tolbert Individual Corporate DirectorBoard Member Jun 1, 2012
Bertha J Oatis Individual Corporate DirectorBoard Member Jun 1, 2009
Paulette T Briscoe Individual Corporate DirectorBoard Member Jun 1, 2009
Christine M McLeod Individual Corporate Director Jan 1, 2021
Angelique S Greer Individual Corporate OfficerCeo Aug 1, 2010
W-2 Managing Employee Aug 1, 2010
Xenia G Wickline Individual Corporate Director Jan 1, 2021
Jane Campbell Individual Corporate Director Jan 1, 2021
Shelby Ward Individual Corporate Director Jan 1, 2021
Shirley Leist Individual Corporate Director Jan 1, 2021
Joseph P Hudson Individual Corporate DirectorBoard Members Jun 1, 2011

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1942298195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494",
            "fax_number": "228-374-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23453 CENTRAL DR",
            "city": "SAUCIER",
            "state": "MS",
            "postal_code": "395747521",
            "telephone_number": "228-832-7223",
            "fax_number": "228-374-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9010021",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C00895",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc - Saucier Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Family Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Coastal Family Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Saucier, MS

Sources for this page

Verify at the official NPI Registry.