Active NPI
Ricardo Costabella
- Community Health Worker
- Dallas, TX
National Provider Identifier
1043816812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 10124
- Practice address
- 4500 Spring Ave
Dallas, TX 75210-1350 - Phone
- (214) 865-3070
- NPI assigned
- Dec 8, 2020
- Last updated
- Dec 8, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 10124 | TX | Primary |
Addresses
Primary practice location
4500 Spring Ave
Dallas, TX 75210-1350
Mailing address
4500 Spring Ave
Dallas, TX 75210-1350
Phone (214) 865-3070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10124 | TX | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1043816812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 SPRING AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752101350",
"telephone_number": "214-865-3070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 SPRING AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752101350",
"telephone_number": "214-865-3070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTABELLA",
"first_name": "RICARDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-08",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "TX",
"license": "10124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
- Joao Paulo Costa Coelho
- Gustavo Costa Medeiros, MD
- Ada Milagros Costa, LCSW
- Belinda Costa
- Krista Lynne Costa, CRNA
- Costco Wholesale Corporation (Costco Hearing Aid #1266)
- Costco Wholesale Corporation (Costco Optical #1266)
- Costco Wholesale Corporation (Costco Pharmacy #1266)
- Kathleen Costello, MD
- Jordan Renae Howell Costen, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.