NPIMap

Individual provider Active NPI

Ann R Costello, MD

  • Internal Medicine Physician
  • Ithaca, NY
National Provider Identifier
1235125626
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
149866 Issued in NY
Practice address
217 N Aurora St
Ithaca, NY 14850-4345
Phone
(607) 273-2811
Fax
(607) 273-1170
NPI assigned
Sep 21, 2005
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 149866 NY Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 149866 NY

Addresses

Primary practice location

217 N Aurora St
Ithaca, NY 14850-4345

Mailing address

217 N Aurora St
Ithaca, NY 14850-4345
Phone (607) 273-2811

Other identifiers 3

IdentifierTypeStateIssuer
000910796001OtherNYHEALTHNOW
00715215MedicaidNY
4217986OtherNYAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20091022000103 NY Practitioner - Internal Medicine 6507903606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Johns Hopkins University School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Internal Medicine of Ithaca PLLCGroup PAC ID 0244504405, 5 clinicians

Practice addresses (Care Compare)

217 N Aurora St
Suite 2
Ithaca, NY 14850-4345
Phone (607) 256-8869

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.27 of 100Reported as apm
Quality
82.87
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
149866NYMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cayuga Medical Associates, PC Internal Medicine PastSince Sep 1, 2006 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ann.costello@costelloandcostellomds.chartmakerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1235125626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 N AURORA ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504345",
            "telephone_number": "607-273-2811",
            "fax_number": "607-273-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 N AURORA ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504345",
            "telephone_number": "607-273-2811",
            "fax_number": "607-273-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "ANN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "149866",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "149866",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNOW",
            "identifier": "000910796001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00715215",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4217986",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.