Matthew D Costello

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

APRN.CRNA.0020479 Issued in OH

Practice address

612 Jillian Frances Cir
Pickerington, OH 43147-1566

Phone

(330) 550-5814

NPI assigned

Jun 30, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Anesthesia Providers, LLCGroup PAC ID 0042558066, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Genesis Hospital Hospital, Zanesville, OH, CCN 360039

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Genesis Anesthesia Providers, LLC

  • Anesthesiology Physician
  • Zanesville, OH
  • NPI 1295205433
  Medicare reassignment Care Compare group NPD

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

• Genesis Healthcare System

  • Community/Retail Pharmacy
  • Zanesville, OH
  • NPI 1184435414

  Hospital

  Care Compare affiliation
• Genesis Healthcare System

  dba Genesis Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Zanesville, OH
  • NPI 1477150951

  Hospital

  Care Compare affiliation
• Genesis Healthcare System

  • General Acute Care Hospital
  • Zanesville, OH
  • NPI 1598868655
  Care Compare affiliation
• Genesis Healthcare System

  dba Genesis Outpatient Pharmacy 1C

  • Community/Retail Pharmacy
  • Coshocton, OH
  • NPI 1710839436

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1538739693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 W WESTERN RESERVE RD UNIT 9C",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445144500",
            "telephone_number": "330-550-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 JILLIAN FRANCES CIR",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431471566",
            "telephone_number": "330-550-5814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-30",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.418095",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "APRN.CRNA.0020479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Meredith Katherine Cousino
• Allen Cox Jr.
• Kristen Nicole Cox, STUDENT

• Certified Registered Nurse Anesthetist in Pickerington, OH
• Providers in Pickerington, OH by specialty
• Certified Registered Nurse Anesthetist in Ohio

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