Individual provider Active NPI

Angela Costanzi, AU.D..CCC-A

  • Audiologist
  • Springfield, MA
National Provider Identifier
1568917854
Registry record updated Aug 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
SP-1110-AU Issued in MA
Practice address
100 Wason Avenue
Suite 100
Springfield, MA 01107
Phone
(413) 732-7426
Fax
(413) 734-2371
NPI assigned
Aug 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X SP-1110-AU MA Primary

Addresses

Primary practice location

100 Wason Avenue
Suite 100
Springfield, MA 01107

Mailing address

100 Wason Avenue
Suite 100
Springfield, MA 01107
Phone (413) 732-7426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161206002202 MA Practitioner - Qualified Audiologist 0446530505 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

45 Francis St
Boston, MA 02115-6105
Phone (617) 732-5500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1110MAMDOccupational Therapy Assistant
SP-1110-AUMAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham & Womens Physicians Organization Inc CurrentSince Sep 26, 2017 Accepting new patients

Locations

45 Francis St
Boston, MA 02115
Phone (617) 332-1700

75 Francis St
Boston, MA 02115

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1568917854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WASON AVENUE",
            "address_2": "SUITE 100",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01107",
            "telephone_number": "413-732-7426",
            "fax_number": "413-734-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WASON AVENUE",
            "address_2": "SUITE 100",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01107",
            "telephone_number": "413-732-7426",
            "fax_number": "413-734-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANZI",
        "first_name": "ANGELA",
        "credential": "AU.D..CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MA",
            "license": "SP-1110-AU",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; 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.