Mary Dacosta, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

V2049 Issued in TX

Practice address

2510 E Main St Ste 102
Alice, TX 78332-4188

Phone

(361) 664-4445

NPI assigned

Apr 1, 2021

Last updated

Jul 14, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford Health NetworkGroup PAC ID 6800707100, 357 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Worthington Medical Center Hospital, Worthington, MN, CCN 240022

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Sanford Health Network

  dba Sanford Clinic Tracy

  • Family Medicine Physician
  • Tracy, MN
  • NPI 1699869875
  Medicare reassignment Care Compare group NPD
• Wellmed Medical Group, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1437156486

  Family Medicine

  Medicare reassignment NPD
• Wellmed Medical Group, P.a.

  dba WellMed Doctor's Hospital Senior Clinic

  • Family Medicine Physician
  • Corpus Christi, TX
  • NPI 1740588243
  NPD
• Sanford Health Network

  dba Sanford Worthington Clinic

  • Family Medicine Physician
  • Worthington, MN
  • NPI 1487685970
  NPD
• Sanford Health Network

  dba Sanford Clinic Mountain Lake

  • Rural Health Clinic/Center
  • Mountain Lake, MN
  • NPI 1568469039
  NPD
• Stella Mattina Health Inc

  • Obstetrics & Gynecology Physician
  • Dallas, TX
  • NPI 1487301230
  NPD (past)

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

• Sanford Health Network

  dba Sanford Worthington Medical Center

  • Rural Acute Care Hospital
  • Worthington, MN
  • NPI 1396712618
  Care Compare affiliation
• Sanford Health Network

  dba Sanford Health Adrian Clinic

  • Rural Acute Care Hospital
  • Worthington, MN
  • NPI 1679859912
  Care Compare affiliation

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1255919965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 MATLOCK RD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152908",
            "telephone_number": "682-509-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 E MAIN ST STE 102",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783324188",
            "telephone_number": "361-664-4445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Matlock Rd",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760152908",
            "country_code": "US",
            "telephone_number": "682-509-6200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DACOSTA",
        "first_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "79645",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "V2049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Country Road Emergency Physicians, PLLC
• Christina Celeste Cruz, LPC
• Cuellar & Cuellar, P.L.L.C.
• Rafael Cuellar Jr., PH.D.
• Carmen Cuevas-Mendoza, LCSW
• Roxanne Daniel-Reyes
• Emma Galvan Delapaz, SLP
• Dental World PLLC
• Dental World-Alice PLLC
• Farzad Deyhim, L.D.

• Family Medicine Physician in Alice, TX
• Providers in Alice, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.