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COASTAL CAROLINA INTERNAL MEDICINE, PA
NPI 1881619740
Clinic/Center - Primary Care in Jacksonville, NC

Active since July 13, 2006CLIA 34D1002872 · Waiver
2420 HENDERSON DR, JACKSONVILLE, NC 28546(910) 937-0008(910) 937-0098 Get Directions Write a Review

NPPES record last updated: October 30, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 30, 2019, Jan 16, 2019 (2 updates tracked since 2019).

About Coastal Carolina Internal Medicine, Pa NPPES

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

COASTAL CAROLINA INTERNAL MEDICINE, PA (NPI 1881619740) is a healthcare organization registered as a primary care in Jacksonville, North Carolina and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through August 15, 2028 and lists Mitzi M Ros, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1881619740
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCOASTAL CAROLINA INTERNAL MEDICINE, PA
Location Address2420 HENDERSON DRJacksonville, NC 28546-5254
Mailing Address2420 Henderson DrJacksonville, NC 28546-5254 · (910) 937-0008 · Fax (910) 937-0098
Phone(910) 937-0008
Fax(910) 937-0098
Organization SubpartNo
Authorized OfficialMitzi M RosOffice Manager · (910) 937-0008
Enumeration DateJuly 13, 2006
Last NPPES UpdateOctober 30, 20192 updates tracked since enumeration
✔ NPI 1881619740 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in NC · 200200443
2420 HENDERSON DR, Jacksonville, NC 28546
Open in Google Maps ↗

Other Identifiers 2

Medicaid8913181NC
Other13181NC · Bcbs Of Nc

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 Carolina Internal 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 Carolina Internal Medicine, PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jose Ros, M.D
Internal Medicine
NPI 1356301634
3245 HENDERSON DR
Jacksonville, NC 28546
(910) 937-0008
✔ PECOS✔ Accepts Medicare0.4 mi

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 34D1002872

Coastal Carolina Internal Medicine PA · Jacksonville, NC
Active · expires Aug 15, 2028
CLIA Number34D1002872
Laboratory TypePhysician Office
Certificate Effective DateAugust 16, 2026
Certificate Expiration DateAugust 15, 2028
Laboratory DirectorJose I. Ros
Laboratory Phone(910) 937-0008
Laboratory LocationCoastal Carolina Internal Medicine PA2420 Henderson Drive, Jacksonville, NC 28546
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 Carolina Internal Medicine, PA's NPI number?

The NPI number for Coastal Carolina Internal Medicine, PA is 1881619740. It was assigned to this organization in the NPPES registry on July 13, 2006.

Where is Coastal Carolina Internal Medicine, PA located?

Coastal Carolina Internal Medicine, PA is located at 2420 Henderson Dr, Jacksonville, NC 28546. The listed phone number is (910) 937-0008.

What is Coastal Carolina Internal Medicine, PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Is Coastal Carolina Internal Medicine, PA enrolled in Medicare?

Yes. Coastal Carolina Internal Medicine, PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Coastal Carolina Internal Medicine, PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Coastal Carolina Internal 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 Carolina Internal Medicine, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D1002872) is associated with this NPI, valid through August 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Coastal Carolina Internal Medicine, PA was last updated on October 30, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.