Nicholas P Costidakis, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

07000748A Issued in IN

Practice address

2606 Veterans Memorial Pkwy S Ste 8
Lafayette, IN 47909-9192

Phone

(765) 447-4776

Fax

(765) 447-4809

NPI assigned

Mar 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hoosier Foot and Ankle LLCGroup PAC ID 8820074750, 20 clinicians

Healthdrive Podiatry Group PCGroup PAC ID 3375446958, 105 clinicians

Upperline Healthcare PCGroup PAC ID 4385900653, 194 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Hoosier Foot and Ankle LLC

  • Foot & Ankle Surgery Podiatrist
  • Jasper, IN
  • NPI 1942492814
  Medicare reassignment Care Compare group NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498

  IN

  Medicare reassignment Care Compare group NPD
• Healthdrive Podiatry Group, PC

  • Podiatrist
  • Dublin, OH
  • NPI 1689613598

  IN

  Medicare reassignment Care Compare group
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Ocoee, FL
  • NPI 1326906843
  NPD
• Westfield Foot and Ankle, LLC

  • Foot & Ankle Surgery Podiatrist
  • Westfield, IN
  • NPI 1821262353
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1972571297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4699",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479034699",
            "telephone_number": "765-449-2732",
            "fax_number": "765-449-1196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 VETERANS MEMORIAL PKWY S STE 8",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479099192",
            "telephone_number": "765-447-4776",
            "fax_number": "765-447-4809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTIDAKIS",
        "first_name": "NICHOLAS",
        "middle_name": "P",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-11",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07000748A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100232960",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10781139",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD NUMBER",
            "identifier": "480034530",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000247376",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nickcostidakis@idx.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "2606 Veterans Memorial Pkwy S Ste 8",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479099192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joline M. Cornell, CRNA
• Cornerstone Caregiving East LLC
• Linda M Corrigan, PH.D.
• Heather Corum, RBT
• Jeremy Costa, PHARMD
• Lisa Lynn Coston, LMHC
• Mary Claire Bass Cote, PA-C
• Counseling Partners LLC
• Shelby Courtney
• Alana Cowan

• Podiatrist in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.