1. Home
  2. Directory
  3. Florida
  4. St Augustine
  5. Podiatrist
  6. NPI Profile

COASTAL FOOT & ANKLE WELLNESS CENTER LLC
NPI 1972834760
Podiatrist - Foot & Ankle Surgery in St Augustine, FL

Active since January 19, 2010
1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084(904) 826-1900(904) 826-1920 Get Directions Write a Review

NPPES record last updated: December 27, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Coastal Foot & Ankle Wellness Center Llc NPPES

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

COASTAL FOOT & ANKLE WELLNESS CENTER LLC (NPI 1972834760) is a healthcare organization registered as a foot & ankle surgery in St Augustine, Florida and active in the NPI registry since January 2010. The organization lists Richard W Johnson, Owner, as its authorized official.

NPPES Registry Identity

NPI1972834760
Entity TypeOrganization
Primary Taxonomy213ES0103X
Legal Business NameCOASTAL FOOT & ANKLE WELLNESS CENTER LLC
Location Address1740 TREE BLVD STE 112St Augustine, FL 32084-5720
Mailing Address1740 Tree Blvd Ste 112St Augustine, FL 32084-5720 · (904) 826-1900 · Fax (904) 826-1920
Phone(904) 826-1900
Fax(904) 826-1920
Organization SubpartNo
Authorized OfficialRichard W JohnsonOwner · (904) 826-1900
Enumeration DateJanuary 19, 2010
Last NPPES UpdateDecember 27, 2020
NPPES CertifiedDecember 27, 2020
✔ NPI 1972834760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
License✔ Licensed in FL · P02829
1740 TREE BLVD STE 112, St Augustine, FL 32084
Open in Google Maps ↗

Other Identifiers 1

Other000NUFL · Bcbs Of Florida

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 Ambetter Health, Ambetter of Alabama, Florida Blue (BlueCross BlueShield FL).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 Foot & Ankle Wellness Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Coastal Foot & Ankle Wellness Center LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Roman Ivankiv
Podiatry
NPI 1528517331
1740 TREE BLVD STE 112
St Augustine, FL 32084
(904) 826-1900
✔ PECOS✔ Accepts MedicareSame address
Jose Concha, DPM
Podiatry
NPI 1992742142
200 SOUTHPARK BLVD SUITE 208
St Augustine, FL 32086
(904) 826-1900
✔ PECOS✔ Accepts Medicare0.5 mi
Richard Johnson, DPM
Podiatry
NPI 1477590248
200 SOUTHPARK BLVD STE 208
St Augustine, FL 32086
(904) 826-1900
✔ PECOS✔ Accepts Medicare0.5 mi

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 Foot & Ankle Wellness Center LLC's NPI number?

The NPI number for Coastal Foot & Ankle Wellness Center LLC is 1972834760. It was assigned to this organization in the NPPES registry on January 19, 2010.

Where is Coastal Foot & Ankle Wellness Center LLC located?

Coastal Foot & Ankle Wellness Center LLC is located at 1740 Tree Blvd Ste 112, St Augustine, FL 32084. The listed phone number is (904) 826-1900.

What is Coastal Foot & Ankle Wellness Center LLC's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Is Coastal Foot & Ankle Wellness Center LLC enrolled in Medicare?

Yes. Coastal Foot & Ankle Wellness Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Coastal Foot & Ankle Wellness Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Podiatry, reassign their Medicare billing to Coastal Foot & Ankle Wellness Center 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, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Coastal Foot & Ankle Wellness Center LLC accept?

Health plans from Ambetter Health, Ambetter of Alabama and Florida Blue (BlueCross BlueShield FL) list Coastal Foot & Ankle Wellness Center LLC 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 Foot & Ankle Wellness Center LLC was last updated on December 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.