NPIMap

Individual provider Active NPI

Jonathan Raymond Da Costa, M.D.

  • Nephrology Physician
  • Miami, FL
National Provider Identifier
1275890170
Registry record updated Nov 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME 123656 Issued in FL
Practice address
1190 NW 95TH St Ste 207
Miami, FL 33150-2064
Phone
(305) 835-7045
Fax
(305) 836-2359
NPI assigned
Apr 16, 2012
Last updated
Nov 4, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME123656 FL
Nephrology Physician 207RN0300X ME 123656 FL Primary

Addresses

Primary practice location

1190 NW 95TH St Ste 207
Miami, FL 33150-2064

Mailing address

1190 NW 95TH St Ste 207
Miami, FL 33150-2064
Phone (305) 835-7045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20150807014550 FL Practitioner - Nephrology 3375857097 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kidney and Hypertension Specialist of Miami PAGroup PAC ID 3476529710, 5 clinicians

Practice addresses (Care Compare)

1190 NW 95TH St
Suite 207
Miami, FL 33150-2064
Phone (305) 835-7045

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 123656FLMDNephrology Physician
ME123656FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Randolph Borrero MD PA CurrentSince May 15, 2024 Accepting new patients
Kidney and Hypertension Specialist of Miami PA Nephrology CurrentSince Sep 18, 2017 Accepting new patients

Locations

1190 NW 95th St
Ste 207
Miami, FL 33150
Phone (305) 400-8518

Interoperability endpoints

  • Direct secure messaging: jonathan.dacosta@direct.davitaphysiciansolutions.com

Organizations & group practices 2

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541289600000",
    "number": "1275890170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 NW 95TH ST STE 207",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331502064",
            "telephone_number": "305-835-7045",
            "fax_number": "305-836-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 NW 95TH ST STE 207",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331502064",
            "telephone_number": "305-835-7045",
            "fax_number": "305-836-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DA COSTA",
        "first_name": "JONATHAN",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-16",
        "last_updated": "2018-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME123656",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME 123656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.