Paul J Kostuchenko, MD

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

200400056 Issued in NC

Practice address

1345 Westgate Center Dr Ste B
Winston Salem, NC 27103-3041

Phone

(336) 768-1280

Fax

(336) 760-8443

NPI assigned

Oct 12, 2005

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 2

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Dermatology

Education

Virginia Commonwealth University, School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Westgate Dermatology and Laser Center, P.a.Group PAC ID 8325104714, 9 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.24 of 100Reported as group

Quality

100

Improvement activities

40

Cost

60.81

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kostuchenko.paul.002.0330038@wede.meditab.direct-ci.com
• Direct secure messaging: kostuchenko.paul.003.0330038@wede.meditab.direct-ci.com

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.

• Westgate Dermatology and Laser Center, P.a.

  • Dermatopathology Physician
  • Winston Salem, NC
  • NPI 1821240995
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1972591055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351-B WESTGATE CENTER DR",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271033041",
            "telephone_number": "336-768-1280",
            "fax_number": "336-760-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 WESTGATE CENTER DR STE B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033041",
            "telephone_number": "336-768-1280",
            "fax_number": "336-760-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTUCHENKO",
        "first_name": "PAUL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NC",
            "license": "200400056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q0005F",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89136R2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bill Gus Kortesis, M.D.
• Carla Mann Koskinas, PA-C
• Brian R Kosobucki, M.D.
• Kostelic & Associates 2, PLLC
• Phillip Martin Kostelic
• Shannon Kostuck, MSW, LCSW-A
• Joshua Kota
• Patrick P Koty, PHD
• Joanna Koudele Koudele, DPT
• Lois Elinor Koufman, LPC

• Dermatopathology Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Dermatopathology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.