NPIMap

Individual provider Active NPI

Angelo Andrew Costas, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1104874791
Registry record updated Mar 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036092729 Issued in IL
Practice address
200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402
Phone
(312) 922-3815
Fax
(312) 922-3789
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036092729 IL Primary

Addresses

Primary practice location

200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402

Mailing address

200 S Michigan Ave
Suite 805
Chicago, IL 60604-2402
Phone (312) 922-3815

Other identifiers 2

IdentifierTypeStateIssuer
0360927291MedicaidIL
036092729OtherILILL LIC #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101217000410 IL Practitioner - Internal Medicine 2062456601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

200 S Michigan Ave
Suite 1400
Chicago, IL 60604-2426
Phone (312) 427-3722

Hospital & facility affiliations

  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Shirley Ryan Abilitylab Inpatient rehabilitation facility, Chicago, IL, CCN 143026
  • Terraces at the Clare Nursing home, Chicago, IL, CCN 146141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
David a Vermylen MD SC Internal Medicine Current Accepting new patients
Shirley Lee Termolen MD SC Internal Medicine Current Accepting new patients
Ami P Desai MD SC Internal Medicine Current Accepting new patients
Angelo a Costas MD SC Internal Medicine CurrentSince Jul 1, 2014 Accepting new patients
Michigan Avenue Internists Internal Medicine Current Accepting new patients

Locations

200 S Michigan Ave
Ste 1400
Chicago, IL 60604
Phone (312) 922-3815

200 S Michigan Ave
Ste 805
Chicago, IL 60604
Phone (312) 922-3815

Organizations & group practices 5

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1104874791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MICHIGAN AVE",
            "address_2": "SUITE 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042402",
            "telephone_number": "312-922-3815",
            "fax_number": "312-922-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S MICHIGAN AVE",
            "address_2": "SUITE 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042402",
            "telephone_number": "312-922-3815",
            "fax_number": "312-922-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTAS",
        "first_name": "ANGELO",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036092729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360927291",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILL LIC #",
            "identifier": "036092729",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.