NPIMap

Individual provider Active NPI

Vincent J Costella, PAC

  • Physician Assistant
  • Greensboro, NC
National Provider Identifier
1336503036
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06358 Issued in NC
Practice address
3511 W Market St Ste 250
Greensboro, NC 27403-4445
Phone
(336) 852-3800
Fax
(336) 852-5725
NPI assigned
Apr 8, 2016
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06358 NC Primary
Surgical Physician Assistant 363AS0400X 0010-06358 NC

Addresses

Primary practice location

3511 W Market St Ste 250
Greensboro, NC 27403-4445

Mailing address

3511 W Market St Ste 250
Greensboro, NC 27403-4445
Phone (336) 852-3800

Other practice location 1

1130 N Church St Ste 200
Greensboro, NC 27401-1041
Phone (336) 272-4578

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address vincent.costellapac.p1@direct.cnsa.nextgenshare.com Direct
Direct Messaging Address Vincent.Costella@eaglep.eclinicaldirectplus.com
Direct Messaging Address Vincent.Costella@eaglep.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20160601002746 NC Practitioner - Physician Assistant 4981994084 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1085 NE Gateway CT NE
Suite 290
Concord, NC 28025-2412
Phone (704) 403-4650

200 Medical Park Dr
Concord, NC 28025-0933

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Apr 25, 2016 Accepting new patients
Cornerstone Health Care, LLC CurrentSince Apr 25, 2016 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Oct 28, 2024 Accepting new patients
Eagle Physicians and Associates PA CurrentSince Nov 28, 2022 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Oct 28, 2024 Accepting new patients
Eagle Physicians and Associates PA Past Accepting new patients
Eagle Physicians and Associates PA Past Accepting new patients

Locations

1085 NE Gateway Ct NE
#200A
Concord, NC 28025
Phone (704) 403-8650

200 Medical Park Dr
Ste 250
Concord, NC 28025
Phone (704) 403-2740

1814 Westchester Dr
Ste 301
High Point, NC 27262
Phone (336) 802-2025

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

Interoperability endpoints

  • Direct secure messaging: vcostella2948873@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: vincent.costella@eaglep.eclinicaldirectplus.com

Organizations & group practices 10

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 3

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": "1460073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1336503036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3511 W MARKET ST STE 250",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274034445",
            "telephone_number": "336-852-3800",
            "fax_number": "336-852-5725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3511 W MARKET ST STE 250",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274034445",
            "telephone_number": "336-852-3800",
            "fax_number": "336-852-5725"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 N Church St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274011041",
            "country_code": "US",
            "telephone_number": "336-272-4578",
            "fax_number": "362-725-9313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLA",
        "first_name": "VINCENT",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-08",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06358",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-06358",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vincent.costellapac.p1@direct.cnsa.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1130 N Church St Ste 200",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274011041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Vincent.Costella@eaglep.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "3511 W Market St Ste A",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274034442",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Vincent.Costella@eaglep.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "3511 W Market St Ste 250",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274034445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.