Joseph Patrick Costello III, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

036079559 Issued in IL

Practice address

4212 N Illinois St
Swansea, IL 62226-1835

Phone

(618) 233-6685

Fax

(618) 233-6616

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. Joseph P Costello III Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Coskids Pediatrics LTD

  • Pediatrics Physician
  • Swansea, IL
  • NPI 1003052028
  NPD (past) Authorized official
• SSM Depaul Medical Group, Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Maryland Heights, MO
  • NPI 1760456743
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322611200000",
    "number": "1073607651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622690217",
            "telephone_number": "618-233-6685",
            "fax_number": "618-233-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N ILLINOIS ST",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622261835",
            "telephone_number": "618-233-6685",
            "fax_number": "618-233-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "JOSEPH",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036079559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "432064512",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "O36079559",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "371390565",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOSEPH",
            "last_name": "COSTELLO",
            "middle_name": "P",
            "prefix": "DR.",
            "suffix": "III",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Cook Counseling Services PLLC
• Janell Cook
• Michael Nunan Cook, LCPC
• David Cooper, RNFA
• Coskids Pediatrics LTD
• Shelbee Coulter
• Kinsey Crawford
• Creating Peace of Mind Cognitive Behavioral Health-LLC (Creating Peace of Mind, LLC)
• Crescent Home Health Agency, LLC (NA)
• Raymond Anthony Crisio, DMD

• Specialist in Swansea, IL
• Providers in Swansea, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.