Individual provider Active NPI

Ryan Kostka, D.O.

  • Surgical Critical Care Physician
  • Fort Worth, TX
National Provider Identifier
1023472107
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
T0543 Issued in TX
Practice address
1500 S Main St FL 2
Fort Worth, TX 76104-4917
Phone
(817) 702-3000
Fax
(817) 927-3958
NPI assigned
Apr 5, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X T0543 TX
Trauma Surgery Physician 2086S0127X T0543 TX
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Critical Care Physician 2086S0102X T0543 TX Primary

Addresses

Primary practice location

1500 S Main St FL 2
Fort Worth, TX 76104-4917

Mailing address

7214 La Vista Dr
Dallas, TX 75214-4226
Phone (720) 201-4084

Other practice location 1

3500 Gaston Ave
Dallas, TX 75246-2017
Phone (214) 820-2361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220201002958 TX Practitioner - Critical Care (Intensivists)Practitioner - General Surgery 5092005595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: General Surgery
Education
Rocky Vista University College of Osteopathic Med, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

1350 S Main St
Suite 1600
Fort Worth, TX 76104-7611
Phone (817) 702-9701

1350 S Main St FL
1 Healing Wings/Infectious Disease
Fort Worth, TX 76104-7611
Phone (817) 702-3701

1450 8TH Ave
Fort Worth, TX 76104-4110
Phone (817) 702-8300

1500 S Main St
Fort Worth, TX 76104-4917

1500 S Main St FL
1 Urgent Care Center
Fort Worth, TX 76104-4917
Phone (817) 702-1451

1575 S Main St
Fort Worth, TX 76104-4901
Phone (817) 702-3431

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.41
Promoting interoperability
100
Improvement activities
40
Cost
78.69

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince Jan 25, 2022 Accepting new patients
Tarrant County Hospital District Past Accepting new patients

Locations

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1250 8th Ave
Ste 600
Fort Worth, TX 76104
Phone (817) 702-7144

200 W Magnolia Ave
Ste 201
Ft Worth, TX 76104
Phone (817) 702-2450

1500 S Main St
Fl 2
Ft Worth, TX 76104
Phone (817) 702-3000

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1023472107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7214 LA VISTA DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752144226",
            "telephone_number": "720-201-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST FL 2",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-3000",
            "fax_number": "817-927-3958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 Gaston Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752462017",
            "country_code": "US",
            "telephone_number": "214-820-2361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTKA",
        "first_name": "RYAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-05",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "T0543",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TX",
            "license": "T0543",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "TX",
            "license": "T0543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.