{"npi":"1770515272","type":"NPI-2","status":"active","name":{"display":"Intracoastal Internal Medicine","other":[],"organization_name":"INTRACOASTAL INTERNAL MEDICINE","authorised_official":"Kimberly Dahlstrom"},"specialty":{"primary_taxonomy":"207R00000X","primary_taxonomy_description":"Internal Medicine","slug":"internal-medicine","schema_org_specialty":"Internal","all":[{"code":"207R00000X","description":"Internal Medicine","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2580 PICKARD RD","city":"WILMINGTON","state":"NC","postal_code":"284034461","country_code":"US","phone":"9103320701","fax":"9103320710"},{"purpose":"MAILING","street_1":"2580 PICKARD RD","city":"WILMINGTON","state":"NC","postal_code":"284034461","country_code":"US","phone":"9103320701","fax":"9103320710"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"5903216","state":"NC","issuer":null},{"type_code":"05","label":"Medicaid","value":"7005481","state":"NC","issuer":null},{"type_code":"05","label":"Medicaid","value":"7005555","state":"NC","issuer":null},{"type_code":"05","label":"Medicaid","value":"1467917880","state":"NC","issuer":null},{"type_code":"05","label":"Medicaid","value":"1447204631","state":"NC","issuer":null},{"type_code":"05","label":"Medicaid","value":"891069V","state":"NC","issuer":null},{"type_code":"05","label":"Medicaid","value":"8911484","state":"NC","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20060921000486","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"NC","pac_id":"2668477878"}]},"enumeration_date":"2006-07-07","last_updated":"2019-06-19","_meta":{"source":"NPPES","snapshot_date":"2019-06-19","doc_url":"https://findmynpi.com/api"}}