Timothy Michael Costa, MD
Individual provider Active NPI Internal Medicine Physician · Fallon, NV
NPI 1265586093 · NPPES record last updated Oct 5, 2020
Key facts
- NPI
- 1265586093
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 6380851-1205 (UT)
- Practice address
- 801 E Williams Ave
Fallon, NV 89406-3052 - Phone
- (775) 867-7740
- Fax
- (775) 423-4219
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Creighton University School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Banner Churchill Community Hospital
Practice addresses (Care Compare)
801 E Williams Ave
Fallon, NV 89406-3052
Hospital & facility affiliations
- Centerwell Home Health
- Eden Home Health
- Banner Churchill Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150901003180 | NV | Practitioner - Internal Medicine | 5698870301 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Banner Health Physicians West LLC | Current |
Accepting new patients | |
| Banner Churchill Community Hospital | Current |
Accepting new patients | |
| Banner Health Physicians West LLC | Current |
Accepting new patients | |
| Banner Churchill Community Hospital | Past | Accepting new patients | |
| Prime Healthcare Services - Reno LLC | Past | Accepting new patients | |
| Mountain Division - CVH, LLC | Past | Accepting new patients | |
| Matthew J Welter MD PC | Past | Accepting new patients | |
| Sparks Family Hospital Inc | Past | Accepting new patients | |
| Mt Grant General Hospital | Past | Accepting new patients |
Locations
801 E Williams Ave
Ste 2210
Fallon, NV 89406
801 E Williams Ave
Fallon, NV 89406
Phone (775) 423-0310
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 6380851-1205 | UT | Yes |
Addresses
Primary practice location
801 E Williams Ave
Fallon, NV 89406-3052
Mailing address
801 E Williams Ave Ste 2210
Fallon, NV 89406-3052
Phone (775) 867-7740
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00379498 | Other | UT | MEDICARE RR |
| DB3302 | Other | UT | MEDICARE RR GROUP |
Other providers in Fallon, NV
- Linda A Conner
- Melissa Caryl Coombs
- Faith Cooper
- Abigail Rochele Cordano
- Jaime Cordoba
- Karen Diane Coutts
- Rick L Cox
- Sunshine Cox
- Charles Crane
- Mary Kathleen Crook
All providers in Fallon, NV · Internal Medicine Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.