Individual provider Active NPI

Jillian Marie Costello, CRNP

  • Acute Care Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1649862103
Registry record updated Feb 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP023213 Issued in PA
Practice address
111 S 11TH St
Philadelphia, PA 19107-4824
Phone
(215) 955-6000
NPI assigned
Feb 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP023213 PA Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4824

Mailing address

401 S Iseminger St
Philadelphia, PA 19147-1113
Phone (609) 560-0541

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmc031@jefferson.edu Health Information Exchange (HIE) Thomas Jefferson University Hospital

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20210728001256 PA Practitioner - Nurse Practitioner 3678976610 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Jefferson Medical College of Thomas Jefferson University, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

925 Chestnut St
Suite 420a
Philadelphia, PA 19107-4204
Phone (215) 955-8516

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Apr 23, 2021 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Jefferson University Physicians PastSince Apr 23, 2021 Accepting new patients

Locations

925 Chestnut St
Ste 420
Philadelphia, PA 19107
Phone (215) 955-8847

833 Chestnut St
Ste 301
Philadelphia, PA 19107
Phone (215) 955-2363

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

2301 S Broad St
Philadelphia, PA 19148
Phone (215) 952-9000

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

925 Chestnut St
Ste 420A
Philadelphia, PA 19107
Phone (215) 955-8516

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1612569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612569600000",
    "number": "1649862103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S ISEMINGER ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471113",
            "telephone_number": "609-560-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "JILLIAN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-06",
        "last_updated": "2021-02-06",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP023213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmc031@jefferson.edu",
            "affiliation": "Y",
            "endpointDescription": "professional email",
            "affiliationName": "Thomas Jefferson University Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "scheduling",
            "address_1": "111 S 11th St",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191074824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.