Mary A Costello, ANP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

100193 Issued in WI

Practice address

525 E 68TH St Ste M404
New York, NY 10065-4870

Phone

(212) 746-5156

NPI assigned

Jul 31, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CO, FL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mac9715@direct.nyp.org
• Direct secure messaging: mcostello203942@direct.peacehealth.org

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.

• Inpatient Services, PC

  • Internal Medicine Physician
  • Brighton, CO
  • NPI 1710999768
  Medicare reassignment NPD
• Tenet Florida Physician Services LLC

  • Surgery Physician
  • West Palm Beach, FL
  • NPI 1659417467
  Medicare reassignment NPD
• Inpatient Services, PC

  • Internal Medicine Physician
  • Littleton, CO
  • NPI 1376388868

  Nurse Practitioner

  NPD
• Portercare Adventist Health System

  • Family Medicine Physician
  • Castle Rock, CO
  • NPI 1730704479
  NPD
• Portercare Adventist Health System

  • Otolaryngology Physician
  • Greenwood Village, CO
  • NPI 1760761928
  NPD
• Portercare Adventist Health System

  • Urology Physician
  • Lakewood, CO
  • NPI 1942165626
  NPD
• Tenet Florida Physician Services, LLC

  • Physical Therapist
  • West Palm Beach, FL
  • NPI 1699111211
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1548426414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 W CAMINO REAL # 255",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334325942",
            "telephone_number": "704-252-1579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST STE M404",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-5156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 W Kk River Pkwy Ste 680",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532153633",
            "country_code": "US",
            "telephone_number": "414-385-1922",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3311 Riverbend Dr",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974778800",
            "country_code": "US",
            "telephone_number": "541-222-2868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "MARY",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-31",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "201508795NP-PP",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "C-APN.0001649-C-NP",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5004075",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "100193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7004305",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1325",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100223521",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devon Elizabeth Costello
• Dolores Costello, N.P.
• Joseph Patrick Costello, PT, DPT
• Kristian Costello
• Lauren Costello, FNP
• Maureen Muchel Costello, DNP, FNP-BC
• Peter C Costello, PH.D.
• Kristine Lalicon Costes, OTR/L
• Marguerite Ann Costich, M.D.
• Julie Marie Costigan, DPT

• Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.