NPIMap

Individual provider Active NPI

Victoria Walker Costello, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Farmington, CT
National Provider Identifier
1265578280
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
54555 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-8400
Fax
(860) 679-8188
NPI assigned
Jan 29, 2007
Last updated
Sep 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01066714A IN
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 54555 CT Primary
Hospitalist Physician 208M00000X 01066714A IN

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

263 Farmington Ave
Farmington, CT 06030-8020
Phone (860) 679-8400

Other practice location 1

615 N Michigan St
South Bend, IN 46601-1033
Phone (574) 647-3500

Other practice location 2

615 N Michigan St
South Bend, IN 46601-1033
Phone (574) 647-3500

Other identifiers 1

IdentifierTypeStateIssuer
200959610MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vcostello33144@direct.med.uchc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20151118000213 CT Practitioner - Geriatric Medicine 7012008055 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
University of Texas Medical School at Houston, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLean FundGroup PAC ID 0648247403, 105 clinicians

Practice addresses (Care Compare)

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3692

75 Great Pond Rd
Simsbury, CT 06070-1980

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01066714AINMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Nov 2, 2015 Accepting new patients
University of Connecticut Health Center CurrentSince May 10, 2019 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Nov 2, 2015 Accepting new patients
University of Connecticut Health Center Internal Medicine CurrentSince May 10, 2019 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

21 South Rd
Farmington, CT 06032
Phone (860) 679-4600

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

1000 Asylum Ave
Ste 2112
Hartford, CT 06105
Phone (860) 714-4749

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

Interoperability endpoints

  • Direct secure messaging: vcostello33144@direct.med.uchc.edu

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1265578280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060308020",
            "telephone_number": "860-679-8400",
            "fax_number": "860-679-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-8400",
            "fax_number": "860-679-8188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 N Michigan St",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011033",
            "country_code": "US",
            "telephone_number": "574-647-3500",
            "fax_number": "574-647-1094",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 N Michigan St",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466011033",
            "country_code": "US",
            "telephone_number": "574-647-3500",
            "fax_number": "574-647-1094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "VICTORIA",
        "middle_name": "WALKER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01066714A",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CT",
            "license": "54555",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01066714A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200959610",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vcostello33144@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.