Mary Marcelle Costantino, MD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

MD26429 Issued in OR

Practice address

6958 SW Varns St
Portland, OR 97223-0000

Phone

(503) 683-7730

Fax

(503) 914-0927

NPI assigned

Sep 14, 2006

Last updated

Jan 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mary Pierznik Former name

Medicare fee-for-service enrollment

Enrolled in OR

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

Interventional Radiology

Education

University of California, Geffen School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

PNW Management GroupGroup PAC ID 3072929884, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Willamette Valley Medical Center Hospital, McMinnville, OR, CCN 380071

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• PNW Management Group

  dba Advanced Vascular Centers Portland

  • Vascular & Interventional Radiology Physician
  • Portland, OR
  • NPI 1588283154
  Medicare reassignment Care Compare group NPD Authorized official
• Advanced Vascular Centers Eugene LLC

  • Vascular & Interventional Radiology Physician
  • Springfield, OR
  • NPI 1255091955
  Medicare reassignment NPD
• Legacy Good Samaritan Hospital and Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1780608216
  Medicare reassignment NPD
• Legacy Good Samaritan Hospital and Medical Center

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1609896174
  NPD
• Legacy Good Samaritan Hospital and Medical Center

  dba Legacy Good Samaritan Providers

  • Clinic/Center
  • Portland, OR
  • NPI 1679597108
  NPD
• TMS Physician Services, P.C.

  • Psychiatry Physician
  • Portland, OR
  • NPI 1881139913
  NPD
• Anesthesia Associates Northwest LLC

  • Anesthesiology Physician
  • Milwaukie, OR
  • NPI 1548281751
  NPD (past)
• Radiology Specialists of the Northwest, PC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1699759498
  NPD (past)

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

• Willamette Valley Medical Center LLC

  dba Willamette Valley Medical Center

  • General Acute Care Hospital
  • McMinnville, OR
  • NPI 1346269982
  Care Compare affiliation

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1407951171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6958 SW VARNS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972230000",
            "telephone_number": "503-683-7730",
            "fax_number": "503-914-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6958 SW VARNS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972230000",
            "telephone_number": "503-683-7730",
            "fax_number": "503-914-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANTINO",
        "first_name": "MARY",
        "middle_name": "MARCELLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD26429",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OR",
            "license": "MD26429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "PIERZNIK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ryan L Costa Morrison
• Andrew Wellman Costa, DO
• Constance Lynn Costa, RN
• Landon James Costante, QMHA
• James D Costantino III, PA-C
• Amy Lynn Costanza-Smith, CCC-SLP
• Costco Wholesale Corporation
• Costco Wholesale Corporation (Costco Hearing Aid #2)
• Costco Wholesale Corporation (Costco Optical #2)
• Brianna Elizabeth-O'Mara Costello, PA-C

• Vascular & Interventional Radiology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Vascular & Interventional Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.