Konstantinos D Kostas, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071005172 Issued in IL

Practice address

4501 N Winchester Ave
2ND FL
Chicago, IL 60640

Phone

(773) 250-0500

Fax

(773) 250-0497

NPI assigned

Mar 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dino Kostas Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bonaventure Medical Foundation LLCGroup PAC ID 7517863178, 164 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Bonaventure Medical Foundation, LLC

  • Family Medicine Physician
  • Elk Grove Village, IL
  • NPI 1588775647
  Medicare reassignment Care Compare group NPD
• Chicago Institute of Neurosurgery & Neuroresearch

  • Neurological Surgery Physician
  • Chicago, IL
  • NPI 1326099391
  NPD (past)

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1629047469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 N WINCHESTER AVE",
            "address_2": "3RD FL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "773-250-0500",
            "fax_number": "773-250-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 N WINCHESTER AVE",
            "address_2": "2ND FL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "773-250-0500",
            "fax_number": "773-250-0497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Biesterfield Rd Ste 610",
            "address_purpose": "LOCATION",
            "city": "Elk Grove Village",
            "state": "IL",
            "postal_code": "600073362",
            "country_code": "US",
            "telephone_number": "847-981-3630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTAS",
        "first_name": "KONSTANTINOS",
        "middle_name": "D",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "konstantino.kostas.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "800 Biesterfield Rd Ste 610",
            "city": "Elk Grove Village",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600073362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DINO",
            "last_name": "KOSTAS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brenna Koss, LPC, NCC
• Sidra Koss, LCP
• Rachael Kossy, LPC
• Jennifer Kost
• Jennifer Rose Kost, PA-C
• Tia Kostas
• Grant Ryan Koster, PT, MSPT, ATC, CSCS
• Anna Kostevich, MD
• Aleksandra Kostic, MD
• Amanda Kostic, NP-C

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.
• 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.