NPIMap

Organization Active NPI

Coastal Plains Community MHMR Center

Doing business as Coastal Plains Community Center

  • Psychiatry Physician
  • Portland, TX
National Provider Identifier
1962552109
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
COASTAL PLAINS COMMUNITY MHMR CENTER
Doing business as
Coastal Plains Community Center
Practice address
200 Marriott Dr
Portland, TX 78374-2213
Phone
(361) 777-3991
Fax
(361) 777-0610
NPI assigned
Jan 11, 2007
Last updated
Nov 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Authorized official

Name
Leonel Trejo
Title
Chief Executive Officer
Phone
(361) 777-3991

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

200 Marriott Dr
Portland, TX 78374-2213

Mailing address

PO Box 1336
Portland, TX 78374-1185
Phone (361) 777-3991

Other identifiers 1

IdentifierTypeStateIssuer
080368601MedicaidTX

Other names 1

  • Coastal Plains Community Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040902000680 TX Part B Supplier - Clinic/Group Practice 1557337490 Receives reassigned benefits from 19 practitioners
5 other NPIs on this enrollment
Practice locations: Beeville, TX; Taft, TX; San Diego, TX; Rockport, TX; Portland, TX; Kingsville, TX; Falfurrias, TX; Aransas Pass, TX…

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Coastal Plains Community Center11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1010 S Commercial St
Aransas Pass, TX 78336
Phone (361) 226-3022

2808 SE Industrial Park Blvd
Beeville, TX 78102
Phone (361) 358-8000

620 E Concho St
Rockport, TX 78382
Phone (361) 727-0988

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1962552109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1336",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783741185",
            "telephone_number": "361-777-3991",
            "fax_number": "361-777-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MARRIOTT DR",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783742213",
            "telephone_number": "361-777-3991",
            "fax_number": "361-777-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PLAINS COMMUNITY MHMR CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "TREJO",
        "authorized_official_first_name": "LEONEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "361-777-3991"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080368601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Plains Community Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.