Active NPI
Connor Costales
- Sports Physical Therapist
- Concord, MA
National Provider Identifier
1053172072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- Practice address
- 50 Beharrell St Ste D
Concord, MA 01742-1750 - Phone
- (617) 932-1027
- NPI assigned
- Jan 17, 2024
- Last updated
- Jan 17, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | Primary |
Addresses
Primary practice location
50 Beharrell St Ste D
Concord, MA 01742-1750
Mailing address
107 College Rd
Concord, MA 01742-1526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
259 Elm St
Suite 204
Somerville, MA 02144-2950
Phone (617) 623-6300
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boston Sports Medicine Inc | Single Specialty | Current | Accepting new patients |
Locations
14 McGrath Hwy
Somerville, MA 02143
Phone (617) 623-4500
259 Elm St
Ste 204
Somerville, MA 02144
Phone (617) 623-6300
Interoperability endpoints
- https://api.platform.athenahealth.com/11813/brand/1/csg/1/fhir/r4
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1053172072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 COLLEGE RD",
"city": "CONCORD",
"state": "MA",
"postal_code": "017421526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 BEHARRELL ST STE D",
"city": "CONCORD",
"state": "MA",
"postal_code": "017421750",
"telephone_number": "617-932-1027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTALES",
"first_name": "CONNOR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-17",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.