Brian John Costello, PHYSICIAN ASSISTANT

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA15532 Issued in CA

Practice address

2405 Shadelands Dr Ste 300
Walnut Creek, CA 94598-5906

Phone

(925) 939-8585

NPI assigned

Oct 10, 2006

Last updated

Jan 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group NPD
• California Sports and Orthopaedic

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Orinda, CA
  • NPI 1649433962
  Medicare reassignment NPD
• Golden State Orthopedics & Spine

  • Orthopaedic Surgery Physician
  • Walnut Creek, CA
  • NPI 1972552990
  Medicare reassignment
• California Sports and Orthopaedic

  • Orthopaedic Surgery Physician
  • Oakland, CA
  • NPI 1619482387
  NPD
• Golden State Orthopedics & Spine

  • Orthopaedic Surgery Physician
  • San Jose, CA
  • NPI 1245021401
  NPD
• Golden State Orthopedics & Spine

  • Orthopaedic Surgery Physician
  • Brentwood, CA
  • NPI 1912252024
  NPD
• Webster Orthopaedic Medical Group, a Professional Corporation

  dba Webster Orthopaedic Medical Group

  • Orthopaedic Surgery Physician
  • Castro Valley, CA
  • NPI 1275564528
  NPD
• Golden State Orthopedics & Spine

  • Orthopaedic Surgery Physician
  • San Francisco, CA
  • NPI 1457004897
  NPD (past)
• Sutter East Bay Medical Foundation

  • Clinical Medical Laboratory
  • Berkeley, CA
  • NPI 1831381623
  NPD (past)
• Sutter East Bay Medical Foundation

  • Family Medicine Physician
  • Orinda, CA
  • NPI 1871538769
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1396833257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31396",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945988396",
            "telephone_number": "925-939-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 SHADELANDS DR STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945985906",
            "telephone_number": "925-939-8585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Porter Dr",
            "address_2": "Suite 215",
            "address_purpose": "LOCATION",
            "city": "San Ramon",
            "state": "CA",
            "postal_code": "945831587",
            "country_code": "US",
            "telephone_number": "925-362-2166",
            "fax_number": "855-574-3055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "BRIAN",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA15532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "975 Sereno Dr",
            "city": "Vallejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945892441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sandy E Cortez, RD CFT
• Jeremy Cosmer, RCP
• Abbie Rose Cosso, DPT
• Adriane E Costa, PT
• Natalie Kate Costales
• John M Cotter III
• Jessica Couch
• Pascale Coucy, NP
• Christopher Coufal, M.D.
• George James Counelis, MD

• Surgical Physician Assistant in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.