Individual provider Active NPI

Elizabeth C Costanzo, DNP

  • Family Nurse Practitioner
  • Cheektowaga, NY
National Provider Identifier
1841967395
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
348321 Issued in NY
Practice address
3085 Harlem Rd Ste 200
Cheektowaga, NY 14225-2591
Phone
(716) 844-5600
Fax
(716) 844-5750
NPI assigned
Aug 24, 2021
Last updated
Aug 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 348321 NY Primary

Addresses

Primary practice location

3085 Harlem Rd Ste 200
Cheektowaga, NY 14225-2591

Mailing address

3085 Harlem Rd Ste 350
Cheektowaga, NY 14225-2591
Phone (716) 844-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20210901000047 NY Practitioner - Nurse Practitioner 2466858360 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Great Lakes Physician PCGroup PAC ID 9133434269, 65 clinicians

Practice addresses (Care Compare)

3085 Harlem Rd
Suite 200
Cheektowaga, NY 14225-2591
Phone (716) 844-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.58 of 100Reported as group
Quality
39.81
Promoting interoperability
88
Improvement activities
40
Cost
83.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
348321NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Physician, PC CurrentSince Aug 30, 2021 Accepting new patients
Great Lakes Physician, PC CurrentSince Aug 30, 2021 Accepting new patients

Locations

3085 Harlem Rd
Ste 200
Cheektowaga, NY 14225
Phone (716) 844-5000

3085 Harlem Rd
Ste 350
Cheektowaga, NY 14225
Phone (716) 844-5000

3850 Saunders Settlement Rd
Sanborn, NY 14132
Phone (716) 898-2800

Interoperability endpoints

  • Direct secure messaging: ecostanzo@qualitycare.medentdirect.com

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 6

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": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1841967395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3085 HARLEM RD STE 350",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142252591",
            "telephone_number": "716-844-5600",
            "fax_number": "716-844-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 HARLEM RD STE 200",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142252591",
            "telephone_number": "716-844-5600",
            "fax_number": "716-844-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANZO",
        "first_name": "ELIZABETH",
        "middle_name": "C",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "348321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheektowaga, NY

Sources for this page

Verify at the official NPI Registry.