Vaneska Bottino Da Costa, M.D.

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

T1020 Issued in TX

Practice address

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Phone

(260) 435-7001

Fax

(260) 435-9763

NPI assigned

Aug 6, 2015

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lutheran Medical Group LLC

  • Cardiovascular Disease Physician
  • Fort Wayne, IN
  • NPI 1164662805

  IN

  Medicare reassignment NPD
• Lutheran Medical Group LLC

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
  • NPI 1710275664
  NPD

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 13, 2023.

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1003292525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3516",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-435-7001",
            "fax_number": "260-435-9763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4845 Alameda Ave",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799052705",
            "country_code": "US",
            "telephone_number": "915-215-5700",
            "fax_number": "915-215-8697",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100297404",
            "country_code": "US",
            "telephone_number": "212-423-7834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTTINO DA COSTA",
        "first_name": "VANESKA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-06",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01091713A",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "T1020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raphael Bosley, LMHC
• Melissa Sue Bosma, MD
• Samuel Thomas Boston, M.D.
• Benjamin Boswell, DDS
• Stacey M Boswell, PA
• Sarah Botts, PT, DPT
• Stephanie Botts, MBA, LAT, ACT
• Paige Boughan
• Bryan Treffley Bourcier, DPT
• Crystal M Bourcier, DPT

• All providers in Fort Wayne, IN
• Pediatric Critical Care Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.