Matias Luis Costa Sr., MD

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

MDFE.FE.61186248 Issued in WA

Practice address

550 17TH Ave
Seattle, WA 98122-5788

Phone

(206) 320-2800

NPI assigned

Jun 28, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1568032076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 DEXTER AVE N APT 202",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981093545",
            "telephone_number": "206-825-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 17TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225788",
            "telephone_number": "206-320-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTA",
        "first_name": "MATIAS",
        "middle_name": "LUIS",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WA",
            "license": "MDFE.FE.61186248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://citrixapps.providence.org/Citrix/citrixappsWeb/",
            "affiliation": "N",
            "address_1": "550 17th Ave",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981225788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracey Cosgrove, PT
• Kristina Moser Cosley, PT
• Sophia Cosmich
• McKenna N Cosottile, PHD
• Beth A. Costa, OT
• James Costakis
• Paul Costanza, PH.D.
• Regeena Nicole Costanzo, LSWAIC
• Celia N Costarella, LMP, BS
• Costco Wholesale Corporation

• All providers in Seattle, WA
• Neurological Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.