Active NPI
Richard Costello, PA-C
- Physician Assistant
- High Point, NC
National Provider Identifier
1922069673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 102803
- Practice address
- 306 Westwood Ave
Suite 401
High Point, NC 27262-4341 - Phone
- (336) 885-6168
- Fax
- (336) 885-6402
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 102803 | NC | Primary |
Addresses
Primary practice location
306 Westwood Ave
Suite 401
High Point, NC 27262-4341
Mailing address
624 Quaker LN
Ste. 207C
High Point, NC 27262-3832
Phone (336) 883-2500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 970016973 | Other | NC | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102803 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Regional Heart Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- High Point, NC
- NPI 1194854646
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1922069673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 QUAKER LN",
"address_2": "STE. 207C",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272623832",
"telephone_number": "336-883-2500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 WESTWOOD AVE",
"address_2": "SUITE 401",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624341",
"telephone_number": "336-885-6168",
"fax_number": "336-885-6402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLO",
"first_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "102803",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "970016973",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in High Point, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.