COASTLINE MEDICAL SERVICES PLLC
NPI 1003361767
Clinic/Center - Medical Specialty in Fort Walton Beach, FL
About Coastline Medical Services Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COASTLINE MEDICAL SERVICES PLLC (NPI 1003361767) is a healthcare organization registered as a medical specialty in Fort Walton Beach, Florida and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through December 20, 2027 and lists Michael Tavernaris, Physician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Coastline Medical Services Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Coastline Medical Services PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Fort Walton Beach, FL 32547
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D2141806
Coastline Medical Services, Plcc · Fort Walton Beach, FLFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Coastline Medical Services PLLC's NPI number?
The NPI number for Coastline Medical Services PLLC is 1003361767. It was assigned to this organization in the NPPES registry on August 23, 2016.
Where is Coastline Medical Services PLLC located?
Coastline Medical Services PLLC is located at 1817 Lewis Turner Blvd Ste F, Fort Walton Beach, FL 32547. The listed phone number is (850) 396-1110.
What is Coastline Medical Services PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.
Is Coastline Medical Services PLLC enrolled in Medicare?
Yes. Coastline Medical Services PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Coastline Medical Services PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Coastline Medical Services PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Coastline Medical Services PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2141806) is associated with this NPI, valid through December 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Coastline Medical Services PLLC was last updated on September 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Coastline Medical Services Pllc · NPI 1003361767
Medical Specialty organization in Fort Walton Beach, Florida. Organization record, active in the CMS NPPES registry since August 23, 2016.
## Identity
- **NPI:** 1003361767 (Entity type: Organization)
- **Enumerated:** August 23, 2016
- **Primary specialty:** Clinic/Center - Medical Specialty · taxonomy 261QM2500X
- **Organization subpart:** No
- **Authorized official:** Michael Tavernaris, PHYSICIAN
## Practice location
- **Address:** 1817 LEWIS TURNER BLVD STE F, Fort Walton Beach, FL 32547-1349
- **Phone:** (850) 396-1110
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 27, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1003361767) · Data from the CMS NPPES public registry.