NPIMap

Individual provider Active NPI

Gregory Daniel Kostur, M.D.

  • Pediatrics Physician
  • Pocatello, ID
National Provider Identifier
1447316799
Registry record updated Jan 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
M-14706 Issued in ID
Practice address
500 S 11TH Ave Ste 204
Pocatello, ID 83201-4878
Phone
(208) 232-3355
Fax
(855) 230-7350
NPI assigned
Dec 29, 2006
Last updated
Jan 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X N3122 TX
Pediatrics Physician 208000000X M-14706 ID Primary

Addresses

Primary practice location

500 S 11TH Ave Ste 204
Pocatello, ID 83201-4878

Mailing address

500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880
Phone (208) 232-7862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20190610001760 ID Practitioner - Pediatric Medicine 6305985086 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-14706IDMDPediatrics Physician
N3122TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health West, Inc. Current Accepting new patients
Health West, Inc. Current Accepting new patients
Health West, Inc. Current Accepting new patients
Health West, Inc. CurrentSince May 14, 2019 Accepting new patients
Health West, Inc. CurrentSince May 14, 2019 Accepting new patients
Health West, Inc. Past Accepting new patients
TMC Provider Group PLLC Past Accepting new patients
Health West, Inc. Past Accepting new patients
Tots N Teens Pediatric Urgent Care PLLC PastSince Jan 15, 2014 Accepting new patients
Health West, Inc. Past Accepting new patients
Health West, Inc. Past Accepting new patients
St. Mark's Medical Center Past Accepting new patients
Health West, Inc. Past Accepting new patients
Health West, Inc. Past Accepting new patients
Health West, Inc. Past Accepting new patients

Locations

823 Reed St
American Falls, ID 83211
Phone (208) 226-2822

152 S 4th St
Montpelier, ID 83254
Phone (208) 847-2108

1000 N 8th Ave
Pocatello, ID 83201
Phone (208) 232-3368

1001 N 7th Ave
Ste 135
Pocatello, ID 83201
Phone (208) 234-2489

465 Memorial Dr
Pocatello, ID 83201
Phone (208) 234-4700

500 S 11th Ave
Ste 204
Pocatello, ID 83201
Phone (208) 232-1443

500 S 11th Ave
Ste 400
Pocatello, ID 83201

880 W Quinn Rd
Pocatello, ID 83202
Phone (208) 238-2000

655 S 4th E
Ste 600
Preston, ID 83263
Phone 20823278621122

Interoperability endpoints

  • Direct secure messaging: gregory.kostur.1@16258.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/7997/brand/1/csg/1/fhir/r4

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704499200000",
    "number": "1447316799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE STE 400",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014880",
            "telephone_number": "208-232-7862",
            "fax_number": "208-232-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE STE 204",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014878",
            "telephone_number": "208-232-3355",
            "fax_number": "855-230-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTUR",
        "first_name": "GREGORY",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N3122",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-14706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.