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COASTAL CAROLINAS INTEGRATED MEDICINE PA
NPI 1649304239
Physical Medicine & Rehabilitation - Pain Medicine in Supply, NC

Active since March 15, 2007CLIA 34D2139750 · Waiver
10 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462(910) 755-6060(910) 939-1659 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Coastal Carolinas Integrated Medicine Pa NPPES

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

COASTAL CAROLINAS INTEGRATED MEDICINE PA (NPI 1649304239) is a healthcare organization registered as a pain medicine in Supply, North Carolina and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through November 7, 2027, maintains a secondary practice location in North Myrtle Beach, and lists Kenneth Lee Willeford, Owner, as its authorized official.

NPPES Registry Identity

NPI1649304239
Entity TypeOrganization
Primary Taxonomy2081P2900X
Legal Business NameCOASTAL CAROLINAS INTEGRATED MEDICINE PA
Location Address10 DOCTORS CIR, SUITE 2Supply, NC 28462-4089
Mailing Address10 Doctors Cir, Suite 2Supply, NC 28462-4089 · (910) 755-6060 · Fax (910) 755-6061
Phone(910) 755-6060
Fax(910) 939-1659
Organization SubpartNo
Authorized OfficialKenneth Lee WillefordOwner · (910) 755-6060
Enumeration DateMarch 15, 2007
Last NPPES UpdateJuly 9, 2025
NPPES CertifiedJuly 9, 2025
✔ NPI 1649304239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical Medicine & Rehabilitation · Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2081P2900X
License✔ Licensed in NC · 36621
Definition
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.
10 DOCTORS CIR, Supply, NC 28462
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Secondary Practice Location 1

Location 1416 Main StNorth Myrtle Beach, SC 29582-3024 · Phone (910) 755-6060 · Fax (910) 939-1659

Other Identifiers 1

Other016UXNC · Bcbs

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Coastal Carolinas Integrated Medicine Pa 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 Coastal Carolinas Integrated Medicine PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kenneth Willeford, M.D.
Interventional Pain Management
NPI 1912917865
10 DOCTORS CIR SUITE 2
Supply, NC 28462
(910) 755-6060
✔ PECOS✔ Accepts MedicareSame address

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 34D2139750

Coastal Carolinas Integrated Medicine · Supply, NC
Active · expires Nov 7, 2027
CLIA Number34D2139750
Laboratory TypePhysician Office
Certificate Effective DateNovember 8, 2025
Certificate Expiration DateNovember 7, 2027
Laboratory DirectorKenneth L. Willeford
Laboratory Phone(910) 755-6060
Laboratory LocationCoastal Carolinas Integrated Medicine10 Doctors Circle, Suite 2, Supply, NC 28462
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Carolinas Integrated Medicine PA's NPI number?

The NPI number for Coastal Carolinas Integrated Medicine PA is 1649304239. It was assigned to this organization in the NPPES registry on March 15, 2007.

Where is Coastal Carolinas Integrated Medicine PA located?

Coastal Carolinas Integrated Medicine PA is located at 10 Doctors Cir Suite 2, Supply, NC 28462. The listed phone number is (910) 755-6060.

What is Coastal Carolinas Integrated Medicine PA's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation, specializing in Pain Medicine, with taxonomy code 2081P2900X.

Is Coastal Carolinas Integrated Medicine PA enrolled in Medicare?

Yes. Coastal Carolinas Integrated Medicine PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Coastal Carolinas Integrated Medicine PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Interventional Pain Management) reassigns their Medicare billing to Coastal Carolinas Integrated Medicine PA. 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 Coastal Carolinas Integrated Medicine PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2139750) is associated with this NPI, valid through November 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Coastal Carolinas Integrated Medicine PA accept?

Health plans from Blue Cross and Blue Shield of NC list Coastal Carolinas Integrated Medicine PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Coastal Carolinas Integrated Medicine PA was last updated on July 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.