Active NPI
Anthony James Costa II
- Internal Medicine Physician
- Grand Blanc, MI
National Provider Identifier
1306686423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4351053098
- Practice address
- 1 Genesys Pkwy
Grand Blanc, MI 48439-8065 - Phone
- (810) 606-5000
- NPI assigned
- May 28, 2024
- Last updated
- May 28, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4351053098 | MI | Primary |
Addresses
Primary practice location
1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Mailing address
54752 Spyria Dr
Shelby TWP, MI 48315-1427
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240719000451 | IN | Order and Referring Only - Internal Medicine | 6406392026 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716854400000",
"number": "1306686423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54752 SPYRIA DR",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483151427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GENESYS PKWY",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398065",
"telephone_number": "810-606-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTA",
"first_name": "ANTHONY",
"middle_name": "JAMES",
"name_suffix": "II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-28",
"last_updated": "2024-05-28",
"certification_date": "2024-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4351053098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.