Individual provider Active NPI

William Arthur Costello Jr., DO

  • Internal Medicine Physician
  • Tampa, FL
National Provider Identifier
1821625542
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS0019812 Issued in FL
Practice address
15310 Amberly Dr
Tampa, FL 33647-2199
Phone
(813) 907-0123
Fax
(813) 907-5559
NPI assigned
Mar 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X OS0019812 FL Primary

Addresses

Primary practice location

15310 Amberly Dr
Tampa, FL 33647-2199

Mailing address

15310 Amberly Dr
Tampa, FL 33647-2199
Phone (813) 907-0123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230712001418 FL Practitioner - Internal Medicine 9436573102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Hospitalists PLGroup PAC ID 9133307788, 18 clinicians

Practice addresses (Care Compare)

15310 Amberly Dr
Suite 250
Tampa, FL 33647-1642
Phone (813) 907-0123

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS0019812FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalists of Florida LLC CurrentSince Jun 1, 2023 Accepting new patients
Premier Hospitalists PL CurrentSince Jul 1, 2023 Accepting new patients
QMC LLC Past Accepting new patients

Locations

26606 Magnolia Blvd
Lutz, FL 33559
Phone (813) 907-0123

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

15310 Amberly Dr
Ste 250
Tampa, FL 33647
Phone (813) 530-5257

3100 E Fletcher Ave
Tampa, FL 33613
Phone (813) 615-7200

1 Tampa General Cir
University of Tampa, FL 33606
Phone (813) 251-0793

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1821625542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15310 AMBERLY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472199",
            "telephone_number": "813-907-0123",
            "fax_number": "813-907-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15310 AMBERLY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472199",
            "telephone_number": "813-907-0123",
            "fax_number": "813-907-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "WILLIAM",
        "middle_name": "ARTHUR",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS0019812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.