Primary Care Internal Medicine of Ithaca, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIMARY CARE INTERNAL MEDICINE OF ITHACA, PLLC

Practice address

217 N Aurora St
Ithaca, NY 14850-4345

Phone

(607) 273-2811

Fax

(607) 273-1170

NPI assigned

Aug 18, 2017

Organization subpart

No

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

Authorized official

Name

Ann R Costello, MDNPI 1235125626

Title

Owner

Phone

(607) 273-2811

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ann R Costello, MD

  • Internal Medicine Physician
  • Ithaca, NY
  • NPI 1235125626
  Medicare reassignment Care Compare group Authorized official
• Jessa Irene Dauria, ARNP

  • Adult Health Nurse Practitioner
  • Ithaca, NY
  • NPI 1013244722
  Medicare reassignment Care Compare group NPD
• Stephanie Gumaer, LCSW

  • Clinical Social Worker
  • Ithaca, NY
  • NPI 1629378062
  Medicare reassignment Care Compare group NPD
• Lucia Jander, MD

  • Internal Medicine Physician
  • Ithaca, NY
  • NPI 1851368732
  Medicare reassignment Care Compare group NPD
• Sally S. Lee, M.D.

  • Nephrology Physician
  • Stratford, CT
  • NPI 1447221189

  NY

  Medicare reassignment Care Compare group NPD
• Elizabeth Marie Pines, D.O.

  • Internal Medicine Physician
  • Cortland, NY
  • NPI 1669906368
  Medicare reassignment NPD
• Christian Larson Stclair, NP

  • Family Nurse Practitioner
  • Bethesda, MD
  • NPI 1770992828

  NY

  Medicare reassignment NPD

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503014400000",
    "number": "1043736309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 N AURORA ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504345",
            "telephone_number": "607-273-2811",
            "fax_number": "607-273-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 N AURORA ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504345",
            "telephone_number": "607-273-2811",
            "fax_number": "607-273-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE INTERNAL MEDICINE OF ITHACA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2017-08-18",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-273-2811",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rubin Man Pradhan
• Elizabeth Predmore, LPN
• Capri Prentice, RN,BSN
• Denise Rae Price, PT
• Hannah Priestley
• Lisa Proctor, NP
• Professional Home Care, Inc.
• Progressive Medicine of Ithaca, PC
• Progressive Neurosurgery, PC
• Kelly Proper, NP

• Internal Medicine Physician in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.