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COASTLINE PRIMARY CARE
NPI 1114572245
Family Medicine - Adult Medicine in Edgewater, FL

Active since August 06, 2019
109 W KNAPP AVE, EDGEWATER, FL 32132(386) 957-4100(386) 957-4104 Get Directions Write a Review

NPPES record last updated: April 26, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 26, 2022, Aug 6, 2019 (2 updates tracked since 2019).

About Coastline Primary Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COASTLINE PRIMARY CARE (NPI 1114572245) is a healthcare organization registered as an adult medicine in Edgewater, Florida and active in the NPI registry since August 2019. The organization lists Carissa Peterson, Owner/aprn, as its authorized official.

NPPES Registry Identity

NPI1114572245
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameCOASTAL ESTHETICS, LLC
Location Address109 W KNAPP AVEEdgewater, FL 32132-1555
Mailing Address109 W Knapp AveEdgewater, FL 32132-1555 · (386) 957-4100 · Fax (386) 957-4104
Phone(386) 957-4100
Fax(386) 957-4104
Organization SubpartNo
Authorized OfficialCarissa PetersonOwner/aprn · (386) 957-4100
Enumeration DateAugust 6, 2019
Last NPPES UpdateApril 26, 20222 updates tracked since enumeration
NPPES CertifiedApril 26, 2022
✔ NPI 1114572245 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
109 W KNAPP AVE, Edgewater, FL 32132
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Other Names 1

Doing Business AsCoastline Primary Care

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 Primary Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Coastline Primary Care, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Carissa Peterson, ARNP
Nurse Practitioner
NPI 1376097105
109 W KNAPP AVE
Edgewater, FL 32132
(386) 957-4100
✔ PECOS✔ Accepts MedicareSame address
Ashley Steiert, NP
Nurse Practitioner
NPI 1982438701
109 W KNAPP AVE
Edgewater, FL 32132
(386) 957-4100
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently 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 Coastal Esthetics, LLC's NPI number?

The NPI number for Coastal Esthetics, LLC is 1114572245. It was assigned to this organization in the NPPES registry on August 6, 2019. The provider is doing business as Coastline Primary Care.

Where is Coastal Esthetics, LLC located?

Coastal Esthetics, LLC is located at 109 W Knapp Ave, Edgewater, FL 32132. The listed phone number is (386) 957-4100.

What is Coastal Esthetics, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Is Coastal Esthetics, LLC enrolled in Medicare?

Yes. Coastal Esthetics, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Coastal Esthetics, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Coastal Esthetics, LLC. 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Coastal Esthetics, LLC was last updated on April 26, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.