Individual provider Active NPI

Leah Harmon Costello, PA

  • Physician Assistant
  • Malvern, AR
National Provider Identifier
1588073738
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-565 Issued in AR
Practice address
1002 Schneider Dr Ste 104
Malvern, AR 72104-4823
Phone
(501) 332-7981
Fax
(501) 337-9964
NPI assigned
Aug 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-565 AR Primary

Addresses

Primary practice location

1002 Schneider Dr Ste 104
Malvern, AR 72104-4823

Mailing address

1002 Schneider Dr Ste 104
Malvern, AR 72104-4823
Phone (501) 337-9994

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address leah.costello@hfcclinic.eclinicaldirectplus.com Shane Higginbotham MD PA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20190212002599 AR Practitioner - Physician Assistant 2567787757 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Health LLCGroup PAC ID 9133519531, 7 clinicians

Practice addresses (Care Compare)

1580 Tanner St
Rockport, AR 72104-2023
Phone (501) 337-9994

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-565ARMDPhysician Assistant

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CBCDCA
  • Direct secure messaging: leah.costello@hfclinic.eclinicaldirectplus.com

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": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1588073738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 SCHNEIDER DR STE 104",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044823",
            "telephone_number": "501-337-9994",
            "fax_number": "501-337-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 SCHNEIDER DR STE 104",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044823",
            "telephone_number": "501-332-7981",
            "fax_number": "501-337-9964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "LEAH",
        "middle_name": "HARMON",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-12",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "leah.costello@hfcclinic.eclinicaldirectplus.com",
            "affiliation": "Y",
            "affiliationName": "Shane Higginbotham MD PA",
            "address_1": "1002 Schneider Dr Ste 104",
            "city": "Malvern",
            "state": "AR",
            "country_code": "US",
            "postal_code": "721044823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Malvern, AR

Sources for this page

Verify at the official NPI Registry.