NPIMap

Individual provider Active NPI

Raquel Alexandra Costlow, FNP

  • Family Nurse Practitioner
  • Boardman, OH
National Provider Identifier
1164003182
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0028706 Issued in OH
Practice address
8401 Market St
Boardman, OH 44512-6725
Phone
(330) 729-2929
NPI assigned
Apr 20, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0028706 OH Primary

Addresses

Primary practice location

8401 Market St
Boardman, OH 44512-6725

Mailing address

1822 Elm Trace St
Austintown, OH 44515-4804
Phone (330) 727-8912

Other names 1

  • Miss Raquel Alexandra Ceballos Mendoza Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20211109002173 OH Practitioner - Nurse Practitioner 5597154781 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1044 Belmont Ave
Youngstown, OH 44504-1006
Phone (330) 480-3655

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0028706OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown LLC CurrentSince Nov 5, 2021 Accepting new patients
Mercy Health Physicians Youngstown, LLC Family Medicine CurrentSince Nov 5, 2021 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

1701 Mercy Health Pl
Cincinnati, OH 45237
Phone (513) 952-5000

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

8401 Market St
Youngstown, OH 44512
Phone (330) 729-2929

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

Interoperability endpoints

  • Direct secure messaging: rcostlow386034@direct.bsmhealth.org

Organizations & group practices 4

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 5

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": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1164003182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 ELM TRACE ST",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445154804",
            "telephone_number": "330-727-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MARKET ST",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126725",
            "telephone_number": "330-729-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTLOW",
        "first_name": "RAQUEL",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Miss",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "0028706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAQUEL",
            "last_name": "CEBALLOS MENDOZA",
            "middle_name": "ALEXANDRA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.