NPIMap

Individual provider Active NPI

Kellie E Costanza, FNP

  • Nurse Practitioner
  • Lakewood, CO
National Provider Identifier
1689229825
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APN.0994790-NP Issued in CO
Practice address
11750 W 2ND PL Ste 255
Lakewood, CO 80228-1726
Phone
(720) 321-8040
Fax
(720) 321-8041
NPI assigned
Aug 5, 2019
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APN.0994790-NP CO Primary

Addresses

Primary practice location

11750 W 2ND PL Ste 255
Lakewood, CO 80228-1726

Mailing address

11750 W 2ND PL Ste 255
Lakewood, CO 80228-1726
Phone (720) 321-8040

Other identifiers 1

IdentifierTypeStateIssuer
9000175874MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191001000173 CO Practitioner - Nurse Practitioner 5294065504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

11600 W 2ND PL
Lakewood, CO 80228-1527

11650 W 2ND PL
Lakewood, CO 80228-1527

11750 W 2ND PL
Lakewood, CO 80228-1726

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado Current Accepting new patients
Portercare Adventist Health System CurrentSince Jan 1, 2023 Accepting new patients
Portercare Adventist Health System Current Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Aug 25, 2019 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Aug 25, 2019 Accepting new patients
Portercare Adventist Health System CurrentSince Jan 1, 2023 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients
Portercare Adventist Health System Past Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

11750 W 2nd Pl
Ste 255
Lakewood, CO 80228
Phone (303) 629-5600

7750 S Broadway
Ste 260
Littleton, CO 80122
Phone (303) 734-8650

7780 S Broadway
Ste 350
Littleton, CO 80122
Phone (303) 734-8650

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1689229825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11750 W 2ND PL STE 255",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281726",
            "telephone_number": "720-321-8040",
            "fax_number": "720-321-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11750 W 2ND PL STE 255",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281726",
            "telephone_number": "720-321-8040",
            "fax_number": "720-321-8041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANZA",
        "first_name": "KELLIE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-05",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0994790-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000175874",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.