Active NPI
Tea Kostandinis, MD
- Family Medicine Physician
- Fulton, MO
National Provider Identifier
1689358103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2023022675
- Practice address
- 110 N Hospital Dr
Fulton, MO 65251-2511 - Phone
- (573) 642-5911
- Fax
- (573) 642-3015
- NPI assigned
- Jun 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2023022675 | MO | Primary |
Addresses
Primary practice location
110 N Hospital Dr
Fulton, MO 65251-2511
Mailing address
1 Hospital Dr
Columbia, MO 65201-5276
Phone (573) 882-6970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230629000705 | MO | Order and Referring Only - Family Practice | 0143689810 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023022675 | MO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686700800000",
"number": "1689358103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HOSPITAL DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652015276",
"telephone_number": "573-882-6970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 N HOSPITAL DR",
"city": "FULTON",
"state": "MO",
"postal_code": "652512511",
"telephone_number": "573-642-5911",
"fax_number": "573-642-3015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSTANDINIS",
"first_name": "TEA",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-14",
"last_updated": "2023-06-14",
"certification_date": "2023-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2023022675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fulton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.