Individual provider Active NPI

Michael William Malone II, PA

  • Physician Assistant
  • Shallotte, NC
National Provider Identifier
1972133346
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-10749 Issued in NC
Practice address
120 Coastal Horizons Dr
Shallotte, NC 28470-6094
Phone
(910) 754-4515
Fax
(910) 202-9966
NPI assigned
Jan 24, 2020
Last updated
Oct 4, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-10749 NC Primary

Addresses

Primary practice location

120 Coastal Horizons Dr
Shallotte, NC 28470-6094

Mailing address

615 Shipyard Blvd
Wilmington, NC 28412-6431

Other practice location 1

615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone (910) 343-0145

Other practice location 2

309 Progress Dr
Burgaw, NC 28425-3280
Phone (910) 259-0668

Other practice location 3

7910 US Hwy 117 S
Rocky Point, NC 28457-9431
Phone (910) 259-0668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201210000429 NC Practitioner - Physician Assistant 9830501113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Horizons Center, Inc.Group PAC ID 9739267964, 50 clinicians

Practice addresses (Care Compare)

120 Coastal Horizons Dr
Shallotte, NC 28470-6094
Phone (910) 343-0145

1414 Medical Ctr Dr
Wilmington, NC 28401-7505
Phone (910) 790-9949

613 Shipyard Blvd
Suite 106
Wilmington, NC 28412-6431
Phone (910) 202-3860

615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone (910) 343-0145

7876 US Hwy 117 S
A
Rocky Point, NC 28457-8408
Phone (910) 259-0668

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Horizons Center Inc CurrentSince Dec 1, 2020 Accepting new patients
Coastal Horizons Center Inc CurrentSince Dec 1, 2020 Accepting new patients

Locations

309 Progress Dr
Burgaw, NC 28425
Phone (910) 259-4526

7910 US Hwy 117 S
Rocky Point, NC 28457
Phone (910) 300-4320

120 Coastal Horizons Dr
Shallotte, NC 28470
Phone (910) 754-4515

615 Shipyard Blvd
Wilmington, NC 28412
Phone (910) 202-5709

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1972133346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 COASTAL HORIZONS DR",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284706094",
            "telephone_number": "910-754-4515",
            "fax_number": "910-202-9966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 Shipyard Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284126431",
            "country_code": "US",
            "telephone_number": "910-343-0145",
            "fax_number": "910-202-9966",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 Progress Dr",
            "address_purpose": "LOCATION",
            "city": "Burgaw",
            "state": "NC",
            "postal_code": "284253280",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7910 US Hwy 117 S",
            "address_purpose": "LOCATION",
            "city": "Rocky Point",
            "state": "NC",
            "postal_code": "284579431",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALONE",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_suffix": "II",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-24",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shallotte, NC

Sources for this page

Verify at the official NPI Registry.