Haley D Kostecki, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.005612 Issued in IL

Practice address

318 US Highway 51 N
Dongola, IL 62926-1103

Phone

(618) 827-3545

Fax

(618) 833-4891

NPI assigned

Oct 1, 2015

Last updated

Apr 25, 2016By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: haley.smith.1@7601.direct.athenahealth.com

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.

• Rural Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Anna, IL
  • NPI 1982666384
  Medicare reassignment NPD
• Rural Health, Inc.

  dba Rural Health Plus

  • Community/Retail Pharmacy
  • Anna, IL
  • NPI 1801634183
  NPD
• Rural Health, Inc.

  dba Dongola Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Dongola, IL
  • NPI 1366506628
  NPD (past)

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

{
    "created_epoch": "1443657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1457721532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061668",
            "telephone_number": "618-833-4471",
            "fax_number": "618-833-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 US HIGHWAY 51 N",
            "city": "DONGOLA",
            "state": "IL",
            "postal_code": "629261103",
            "telephone_number": "618-827-3545",
            "fax_number": "618-833-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTECKI",
        "first_name": "HALEY",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-01",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.005612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A. Ruth Dodd, LMT
• Dongola SCH Unit Dist 66
• Dongola SCH Unit Dist 66
• Dongola School Unit Dist 66
• Cheryl A Fuller, APN
• Rural Health, Inc. (Dongola Medical Clinic)

• Physician Assistant in Dongola, IL
• Providers in Dongola, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.