Priyanka Costa Hennis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

62955 Issued in AZ

Practice address

3811 E Bell Rd Ste 106
Phoenix, AZ 85032-2158

Phone

(602) 443-1085

Fax

(602) 443-1086

NPI assigned

Jul 20, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Honor Health John C. Lincoln Medical Center Hospital, Phoenix, AZ, CCN 030014

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Costa Clinic PLLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1366218414
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Honorhealth

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1770690695
  Care Compare affiliation

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

{
    "created_epoch": "1374278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1346682291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 E BELL RD STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322158",
            "telephone_number": "602-443-1085",
            "fax_number": "602-443-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 E BELL RD STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322158",
            "telephone_number": "602-443-1085",
            "fax_number": "602-443-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTA HENNIS",
        "first_name": "PRIYANKA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-20",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "62955",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35136107",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2016-01798",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adria Rene Cory, COTA/L
• Nikitshia Corzo, MA, BCBA
• Jonathan Cosme Berrios, M.D.
• Amelia Cossio, AA
• Costa Clinic PLLC
• Jeanette Marie Costa, MA, LPC
• John Albert Costa, MD
• Tara Costa, LAMFT
• Jesse Lee Costales, M.D.
• Theresa L. Costales, M.D.

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.
• 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.