Coastal Carolina Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COASTAL CAROLINA PRIMARY CARE, LLC

Doing business as

Doc At The Door

Practice address

3601 Ladson Rd
Suite 101
Ladson, SC 29456-4304

Phone

(843) 821-0733

Fax

(843) 821-0925

NPI assigned

Feb 22, 2010

Organization subpart

No

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

Authorized official

Name

Wayne O. Winney

Title

Vice President

Phone

(843) 847-4054

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Doc At The Door Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Coastal Carolina Primary Care, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Myrtle Beach, SC
  • NPI 1821257676

  O20090309000437

  Same enrollment

Locations

Practitioners 1

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

• Robert E Kimpton, MD

  • Family Medicine Physician
  • Myrtle Beach, SC
  • NPI 1407916133
  NPD

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

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273017600000",
    "number": "1942522719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 LADSON RD",
            "address_2": "SUITE 101",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564304",
            "telephone_number": "843-821-0733",
            "fax_number": "843-821-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 LADSON RD",
            "address_2": "SUITE 101",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564304",
            "telephone_number": "843-821-0733",
            "fax_number": "843-821-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-22",
        "last_updated": "2010-05-05",
        "status": "A",
        "authorized_official_last_name": "WINNEY",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "843-847-4054"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942522719",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5390",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doc At The Door",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanya Chmunevich, CCC-SLP
• Kaitlyn Cingel, SLP
• Samantha Lynn Cliborne, BCBA
• Bailee Cloutier, OTR/L
• Coastal Carolina Podiatry Inc
• Anthony Coaxum, PHARMD
• Kristi Cockrell
• Jacqueline Cohn, RN
• Jason B Coker, M.D.
• Mark A Coker, M.D.

• Family Medicine Physician in Ladson, SC
• Providers in Ladson, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2010; 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.