Mary Colleen Costello, MD
Individual provider Active NPI Pediatric Emergency Medicine (Pediatrics) Physician · Aurora, CO
NPI 1306138672 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1306138672
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X
- License
- DR.0070286 (CO)
- Practice address
- 13123 E 16TH Ave
Aurora, CO 80045-7106 - Phone
- (720) 777-1234
- NPI assigned
- May 5, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230128000373 | TN | Practitioner - Pediatric Medicine |
8224409339 | Reassigns benefits to 1 organization |
| I20230502001508 | CO | Practitioner - Emergency Medicine |
8224409339 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD47246 | TN | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Physicians Incorporated | Pediatrics | Current |
Accepting new patients |
| University Physicians, Incorporated | Current |
Accepting new patients | |
| Children'S Hospital Colorado | Current | Accepting new patients | |
| Southeastern Emergency Physicians LLC | Emergency Medicine | Current |
Accepting new patients |
| University Physicians Incorporated | Emergency Medicine | Current | Accepting new patients |
Locations
13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846
Dept 1061
Denver, CO 80256
1811 Plaza Dr
Highlands Ranch, CO 80129
Phone (720) 478-0108
9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000
2018 Clinch Ave
Knoxville, TN 37916
Phone (865) 541-8000
Interoperability endpoints
- mcostello261963@direct.childrenscolorado.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD47246 | TN | |
| Pediatrics Physician | 208000000X | MD47246 | TN | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | MD47246 | TN | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | DR.0070286 | CO | Yes |
Addresses
Primary practice location
13123 E 16TH Ave
Aurora, CO 80045-7106
Mailing address
PO Box 110429
Aurora, CO 80042-0429
Other practice location 1
2018 W Clinch Ave
Knoxville, TN 37916-2301
Phone (865) 541-8000
Other providers in Aurora, CO
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- Katherine Costello
- Lisa Humphrey Costello
- Suzanne Cota
- Jillian Mayer Cotter
- Alyssa Cottle
- Yahdi D Cotto-Jorge
- Jake Logan Cotton
All providers in Aurora, CO · Pediatric Emergency Medicine (Pediatrics) Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.