NPIMap

Individual provider Active NPI

David Costello, C.R.N.P.

  • Family Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1104053420
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904287 Issued in MS
Practice address
4300 15TH St
Gulfport, MS 39501-2524
Phone
(228) 864-0828
NPI assigned
Jun 12, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-064521 AL
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 904287 MS Primary

Addresses

Primary practice location

4300 15TH St
Gulfport, MS 39501-2524

Mailing address

12825 Hanover Dr
Ocean Springs, MS 39564-2612
Phone (205) 470-3721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091027000282 AL Practitioner - Nurse Practitioner 5092852921 Reassigns benefits to 1 organization
I20201228000816 MS Practitioner - Nurse Practitioner 5092852921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Ear, Nose and Throat, Head and Neck Surgery Associates, PLLCGroup PAC ID 0042280067, 8 clinicians

Practice addresses (Care Compare)

4300 15TH St
Gulfport, MS 39501-2524
Phone (228) 864-0828

Hospital & facility affiliations

  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Ear, Nose and Throat, Head and Neck Surgery Associates, PLLC Single Specialty CurrentSince Dec 7, 2020 Accepting new patients
University of Alabama Health Services Foundation, PC. Single Specialty CurrentSince Oct 22, 2010 Accepting new patients
University of Alabama Health Services Foundation, PC Single Specialty CurrentSince Oct 22, 2010 Accepting new patients
Alteon Health Alabama, LLC Single Specialty Past Accepting new patients
Southern Medical Group, Inc Single Specialty Past Accepting new patients
Coast Heart Institute, PLLC Single Specialty PastSince Dec 7, 2020 Accepting new patients

Locations

1600 7th Ave S
Birmingham, AL 35233
Phone (205) 638-9100

1720 2nd Ave S
#503
Birmingham, AL 35294
Phone (205) 934-2006

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

4300 15th St
Gulfport, MS 39501
Phone (228) 863-5211

3017 13th St
Gulfport, MS 39501
Phone (228) 831-0050

4300 15th St
#B
Gulfport, MS 39501
Phone (228) 864-0828

Interoperability endpoints

  • Direct secure messaging: dcostello@direct.uabmedicine.org

Organizations & group practices 6

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.

Hospital & facility affiliations 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1104053420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12825 HANOVER DR",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395642612",
            "telephone_number": "205-470-3721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 15TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012524",
            "telephone_number": "228-864-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "DAVID",
        "credential": "C.R.N.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-12",
        "last_updated": "2022-08-09",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-064521",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.