Organization Active NPI

Costus Medical Inc

  • Family Medicine Physician
  • Missouri City, TX
National Provider Identifier
1336906346
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COSTUS MEDICAL INC
Practice address
2710 FM 1092 Rd Ste E
Missouri City, TX 77459-5641
Phone
(832) 645-4156
Fax
(832) 645-5146
NPI assigned
Mar 5, 2024
Last updated
Jun 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Authorized official

Name
Yemi Adesola
Title
Admin/Managing Member
Phone
(832) 645-4156

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Integrative Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 202D00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2710 FM 1092 Rd Ste E
Missouri City, TX 77459-5641

Mailing address

2710 FM 1092 Rd Ste E
Missouri City, TX 77459-5641
Phone (832) 645-4156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241010003927 TX Part B Supplier - Clinic/Group Practice 4183156474 Receives reassigned benefits from 4 practitioners
Practice locations: Missouri City, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2317671Costus Medical Clinic2710 FM 1092 Rd, Suite E, Missouri City, TX 77459Certificate of waiverJan 28, 2027

National Provider Directory

National Provider Directory

Locations

2710 FM 1092 Rd
Ste E
Missouri City, TX 77459
Phone (832) 650-0364

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1336906346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 FM 1092 RD STE E",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774595641",
            "telephone_number": "832-645-4156",
            "fax_number": "832-645-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 FM 1092 RD STE E",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774595641",
            "telephone_number": "832-645-4156",
            "fax_number": "832-645-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTUS MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "ADESOLA",
        "authorized_official_first_name": "YEMI",
        "authorized_official_title_or_position": "ADMIN/MANAGING MEMBER",
        "authorized_official_telephone_number": "832-645-4156"
    },
    "taxonomies": [
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missouri City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.