Phyllis Pelfrey Costello, MSN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN158279 Issued in GA

Practice address

3647 J Dewey Gray Cir Ste 200
Augusta, GA 30909-2205

Phone

(706) 504-9712

Fax

(706) 504-9703

NPI assigned

Oct 11, 2013

Last updated

Feb 9, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Nurse Practitioner

Education

Medical College of Georgia School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Augusta Primary Care Services LLCGroup PAC ID 2466513874, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Doctors Hospital Hospital, Augusta, GA, CCN 110177

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

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.

• Augusta Primary Care Services LLC

  • Internal Medicine Physician
  • Augusta, GA
  • NPI 1952565210
  Medicare reassignment Care Compare group NPD
• Pruitthealth Hospice, Inc

  dba PruittHealth Hospice - Swainsboro

  • Community Based Hospice Care Agency
  • Swainsboro, GA
  • NPI 1013955749
  Medicare reassignment NPD
• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - Augusta

  • Community Based Hospice Care Agency
  • Augusta, GA
  • NPI 1780622902
  NPD
• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - Eastern Carolina

  • Community Based Hospice Care Agency
  • Greenville, NC
  • NPI 1992744361
  NPD
• Burn and Reconstructive Centers of Virginia, PLLC

  • Specialist
  • Richmond, VA
  • NPI 1194346734
  NPD (past)

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

• Doctors Hospital of Augusta LLC

  dba Doctors Hospital (Augusta)

  • General Acute Care Hospital
  • Augusta, GA
  • NPI 1912951963
  Care Compare affiliation

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

{
    "created_epoch": "1381449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1487081261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3548",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309143548",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3647 J DEWEY GRAY CIR STE 200",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309092205",
            "telephone_number": "706-504-9712",
            "fax_number": "706-504-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "PHYLLIS",
        "middle_name": "PELFREY",
        "name_prefix": "Mrs.",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-11",
        "last_updated": "2022-02-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN158279",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN158279",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PHYLLIS.COSTELLO@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "3647 J Dewey Gray Cir Ste 200",
            "city": "Augusta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "309092205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Nurse Practitioner in Augusta, GA
• Providers in Augusta, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.