NPIMap

Individual provider Active NPI

Frederick M Costello, MD

  • Interventional Cardiology Physician
  • Boise, ID
National Provider Identifier
1285851337
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
M10231 Issued in ID
Practice address
8854 W Emerald St Ste 260
Boise, ID 83704-4860
Phone
(208) 398-4306
NPI assigned
Apr 19, 2007
Last updated
Jul 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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 200400112 NC
Interventional Cardiology Physician 207RI0011X M10231 ID Primary

Addresses

Primary practice location

8854 W Emerald St Ste 260
Boise, ID 83704-4860

Mailing address

8854 W Emerald St Ste 260
Boise, ID 83704-4860
Phone (208) 398-4306

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080610000335 ID Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6406926948 Reassigns benefits to 3 organizations
I20110505000642 OR Practitioner - Cardiovascular Disease (Cardiology) 6406926948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
University of Washington School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
High Desert Heart and VascularGroup PAC ID 7113389909, 10 clinicians

Practice addresses (Care Compare)

3015 E Goldstone Dr
Suite 230
Meridian, ID 83642-1224
Phone (208) 781-6039

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting52

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200400112NCMDInternal Medicine Physician
M10231IDMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Canyon Medical Center, Inc. CurrentSince Jun 10, 2009 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Internal Medicine CurrentSince Mar 1, 2012 Accepting new patients
High Desert Heart & Vascular Cardiovascular Disease CurrentSince Jul 1, 2023 Accepting new patients
North Canyon Medical Center Inc. Current Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Jun 10, 2009 Accepting new patients

Locations

100 E Idaho St
Boise, ID 83712
Phone (208) 343-3223

130 E Boise Ave
Boise, ID 83706
Phone (208) 345-4066

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

8854 W Emerald St
Ste 260
Boise, ID 83704
Phone (208) 398-4306

267 N Canyon Dr
Gooding, ID 83330
Phone (208) 934-4433

3015 E Goldstone Dr
Ste 230
Meridian, ID 83642
Phone (208) 398-4306

520 S Eagle Rd
Ste 3104
Meridian, ID 83642
Phone (208) 373-1200

895 N 6th E
Mtn Home, ID 83647
Phone (208) 580-2661

3950 17th St
Baker City, OR 97814
Phone (541) 523-1001

3950 17th St
Ste A
Baker City, OR 97814
Phone (541) 523-1001

Interoperability endpoints

  • Direct secure messaging: fcostello13842@direct.slhs.org
  • Direct secure messaging: fred.costello.p47@direct.newportmed.nextgenshare.com
  • Direct secure messaging: frederick.costellomd.p47@direct.hdhv.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 9

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": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1285851337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 260",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044860",
            "telephone_number": "208-398-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 260",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044860",
            "telephone_number": "208-398-4306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "FREDERICK",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200400112",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ID",
            "license": "M10231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.