Michael Costello, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601003192 Issued in MI

Practice address

4967 Crooks Rd
Suite 120
Troy, MI 48098-5801

Phone

(248) 952-1601

Fax

(248) 952-5781

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mcostello1123896@direct.hfhs.org

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.

• Great Lakes Medicine, PLC

  • Hospitalist Physician
  • Shelby Township, MI
  • NPI 1740210517
  Medicare reassignment
• Henry Ford Health St. John Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  Medicare reassignment
• Medicure Internists PC

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1144201880
  Medicare reassignment
• Henry Ford Health St. John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088
  NPD
• Pathology Specialists of Southeast Michigan PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
  • NPI 1023100500
  NPD
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD
• St. John Hospital

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1649355918
  NPD (past)

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342483200000",
    "number": "1083609192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4967 CROOKS RD",
            "address_2": "SUITE 120",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480985801",
            "telephone_number": "248-952-1601",
            "fax_number": "248-952-5781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4967 CROOKS RD",
            "address_2": "SUITE 120",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480985801",
            "telephone_number": "248-952-1601",
            "fax_number": "248-952-5781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "MICHAEL",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2012-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela Cortez
• Christine Cory, LLPC
• Sheenah Lee Cosey-Knowles
• Seid Cosovic, MD
• Corinne Dianne Costellic, DO
• Jeffrey M. Cothran, PA
• Alexa Cotter
• Patrick Coughlin
• Patrick Coulter, P.A.
• Counseling and Housing Solutions LLC

• Medical Physician Assistant in Troy, MI
• Providers in Troy, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.