Coastal Vein Vascular Institute – Diagnostic Radiology Physician, NPI 1093782070
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Coastal Vein Vascular Institute
8375 DIX ELLIS TRL STE 201
JACKSONVILLE, FL 322568241
Phone: (904) 399-5550
Fax: (904) 346-4334
Type: Location
PO BOX 116700
ATLANTA, GA 303686700
Phone: (904) 399-5550
Fax: (904) 346-4334
Type: Mailing
Brooks Rehabilitation Hospital, 3599, University Boulevard South, Englewood, Jacksonville, Duval County, Florida, 32216, United States
BUILDING 300
JACKSONVILLE, FL 322164252
Phone: (904) 399-5550
Fax: (904) 346-4334
Type: Mailing
PO BOX 85497
CHICAGO, IL 606895497
Phone:
Fax: (904) 346-4334
Type: Mailing
1 TAMPA GENERAL CIR
TAMPA, FL 336063571
Phone: (904) 236-5884
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-09-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (980 days ago).
Enrollment records
48
Earliest due date
2023-09-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040714001317 | O | Clinic/Group Practice | FL | 2023-09-30 |
| O20141013000603 | O | Clinic/Group Practice | HI | 2023-09-30 |
| O20180213003165 | O | Clinic/Group Practice | AZ | 2024-07-31 |
| O20190711001859 | O | Clinic/Group Practice | CO | 2024-08-31 |
| O20190717002243 | O | Clinic/Group Practice | TX | 2024-09-30 |
| O20190729002602 | O | Clinic/Group Practice | AL | 2024-10-31 |
| O20190730000895 | O | Clinic/Group Practice | MI | 2025-07-31 |
| O20190917004315 | O | Clinic/Group Practice | NC | 2025-06-30 |
| O20191111002152 | O | Clinic/Group Practice | CA | 2025-11-30 |
| O20200226001916 | O | Clinic/Group Practice | PA | 2025-10-31 |
| O20200306002073 | O | Clinic/Group Practice | GA | 2025-11-30 |
| O20200506002121 | O | Clinic/Group Practice | RI | 2026-01-31 |
| O20200506003030 | O | Clinic/Group Practice | NV | 2026-02-28 |
| O20200511000102 | O | Clinic/Group Practice | DC | 2026-02-28 |
| O20200511003424 | O | Clinic/Group Practice | TN | 2026-03-31 |
| O20200519000806 | O | Clinic/Group Practice | OR | 2026-06-30 |
| O20200519001020 | O | Clinic/Group Practice | GU | 2026-04-30 |
| O20200521003033 | O | Clinic/Group Practice | KY | 2026-05-31 |
| O20200522002661 | O | Clinic/Group Practice | SC | 2026-06-30 |
| O20200609000704 | O | Clinic/Group Practice | MT | 2026-07-31 |
| O20200610001970 | O | Clinic/Group Practice | OH | 2026-07-31 |
| O20200625000274 | O | Clinic/Group Practice | MS | 2026-08-31 |
| O20200908002330 | O | Clinic/Group Practice | WI | 2026-09-30 |
| O20200921000939 | O | Clinic/Group Practice | NE | 2026-10-31 |
| O20201203000372 | O | Clinic/Group Practice | LA | TBD |
| O20210302002374 | O | Clinic/Group Practice | IL | TBD |
| O20210505000069 | O | Clinic/Group Practice | MD | TBD |
| O20210608003323 | O | Clinic/Group Practice | NY | TBD |
| O20210624000499 | O | Clinic/Group Practice | MN | TBD |
| O20210628002584 | O | Clinic/Group Practice | VA | TBD |
| O20210929000731 | O | Clinic/Group Practice | OK | TBD |
| O20211011000288 | O | Clinic/Group Practice | MO | TBD |
| O20211012000512 | O | Clinic/Group Practice | DE | TBD |
| O20220303000736 | O | Clinic/Group Practice | ID | TBD |
| O20220309000945 | O | Clinic/Group Practice | ME | TBD |
| O20220408000998 | O | Clinic/Group Practice | IA | TBD |
| O20220418000872 | O | Clinic/Group Practice | WA | TBD |
| O20220420002318 | O | Clinic/Group Practice | KS | TBD |
| O20220421001227 | O | Clinic/Group Practice | NH | TBD |
| O20220421002160 | O | Clinic/Group Practice | MA | TBD |
| O20220509000584 | O | Clinic/Group Practice | CT | TBD |
| O20220610000249 | O | Clinic/Group Practice | NJ | TBD |
| O20220818001222 | O | Clinic/Group Practice | IN | TBD |
| O20230220002180 | O | Clinic/Group Practice | UT | TBD |
| O20230320001431 | O | Clinic/Group Practice | NM | TBD |
| O20231024004175 | O | Clinic/Group Practice | PR | TBD |
| O20231102000700 | O | Clinic/Group Practice | WV | TBD |
| O20250923003801 | O | Clinic/Group Practice | AK | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32256)
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