Christopher P Costa MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20028 Issued in NE

Legal business name

CHRISTOPHER P COSTA MD PC

Practice address

514 9TH Street
Gothenburg, NE 69138-1917

Phone

(308) 537-2222

Fax

(308) 537-2960

NPI assigned

Nov 2, 2006

Organization subpart

No

Name

Christopher P Costa, MDNPI 1588669832

Title

Owner

Phone

(308) 537-2222

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher P. Costa, M.D.

  • Family Medicine Physician
  • Los Banos, CA
  • NPI 1588669832

  Family Medicine

  NPD (past) Authorized official
• Vaughan A Wenzel, PA-C

  • Physician Assistant
  • Papillion, NE
  • NPI 1053367979
  NPD (past)
• Lety Elizabeth Costa, MD

  • Internal Medicine Physician
  • Dos Palos, CA
  • NPI 1821188269

  Family Medicine

  NPD (past)

Locations

• Costa Family Practice Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 16, 2007.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1194803353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 9TH STREET",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381917",
            "telephone_number": "308-537-2222",
            "fax_number": "308-537-2960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 9TH STREET",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381917",
            "telephone_number": "308-537-2222",
            "fax_number": "308-537-2960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTOPHER P COSTA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "308-537-2222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "20028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH MEDICAID",
            "identifier": "10025207300",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RIVERBEND",
            "identifier": "283850",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025207400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costa Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Lou Block, RDN LMNT
• Melissa Anne Brill, APRN FAMILY NURSE PR
• Hunter Brimm
• Sue Britt
• Carol Shackleton, M.D., P.C.
• City of Gothenburg
• Blaine Michael Cornelius, P.A.
• Craig D Bartruff M.D., P.C.
• Craig D Bartruff, M.D., P.C.
• John Alan Daup, OTR/L

• All providers in Gothenburg, NE
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.