NPIMap

Individual provider Active NPI

Justine Kostrub, MD

  • Family Medicine Physician
  • Sewickley, PA
National Provider Identifier
1386057776
Registry record updated Jul 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD461424 Issued in PA
Practice address
720 Blackburn Rd FL 1
Sewickley, PA 15143-1459
Phone
(412) 741-0985
Fax
(412) 749-6785
NPI assigned
Jun 4, 2014
Last updated
Jul 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT-207188 PA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD461424 PA Primary

Addresses

Primary practice location

720 Blackburn Rd FL 1
Sewickley, PA 15143-1459

Mailing address

720 Blackburn Rd., 1St Floor
Sewickley, PA 15143
Phone (412) 741-0985

Other identifiers 1

IdentifierTypeStateIssuer
103147653MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20170817001501 PA Practitioner - Family Practice 4587969183 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Temple University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

720 Blackburn Rd
Sewickley, PA 15143-1459
Phone (412) 749-7127

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT-207188PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Heritage Valley Multispecialty Group, Inc. Multi-Specialty CurrentSince Jul 31, 2017 Accepting new patients
Heritage Valley Multispecialty Group, Inc. Multi-Specialty CurrentSince Jul 31, 2017 Accepting new patients

Locations

500 Sharon Rd
Beaver, PA 15009
Phone (724) 728-7683

2 Peartree Way
Beaver, PA 15009
Phone (724) 773-6802

720 Blackburn Rd
Fl 1
Sewickley, PA 15143
Phone (412) 741-0985

720 Blackburn Rd
Sewickley, PA 15143
Phone (412) 741-6600

Interoperability endpoints

  • Direct secure messaging: justinekostrub@hvhs.allscriptsdirect.net

Organizations & group practices 2

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499644800000",
    "number": "1386057776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 BLACKBURN RD., 1ST FLOOR",
            "city": "SEWICKLEY",
            "state": "PA",
            "postal_code": "15143",
            "telephone_number": "412-741-0985",
            "fax_number": "412-749-6785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 BLACKBURN RD FL 1",
            "city": "SEWICKLEY",
            "state": "PA",
            "postal_code": "151431459",
            "telephone_number": "412-741-0985",
            "fax_number": "412-749-6785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTRUB",
        "first_name": "JUSTINE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-04",
        "last_updated": "2017-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT-207188",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD461424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103147653",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewickley, PA

Sources for this page

Verify at the official NPI Registry.