Petronilo R Costa, MD is a medicare enrolled "Preventive Medicine - Undersea And Hyperbaric Medicine" physician in Deerfield, Illinois. His current practice location is
420 Lake Cook Rd Ste 118, Deerfield, Illinois. You can reach out to his office (for appointments etc.) via phone at
(847) 205-0237.
Petronilo R Costa is licensed to practice in Illinois (license number 036-046-108) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1043435340.
Physician's Profile
| Full Name | Petronilo R Costa |
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| Gender | Male |
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| Speciality | Preventive Medicine - Undersea And Hyperbaric Medicine |
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| Location | 420 Lake Cook Rd Ste 118, Deerfield, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1043435340
- Provider Enumeration Date: 04/13/2007
- Last Update Date: 10/12/2016
Medicare PECOS Information:
- PECOS PAC ID: 0244266872
- Enrollment ID: I20050714000368
Medical Identifiers
Medical identifiers for Petronilo R Costa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1043435340 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | 036-046-108 (Illinois) | Primary |
| 208000000X | Pediatrics | 036-046-108 (Illinois) | Secondary |
| 2080A0000X | Pediatrics - Adolescent Medicine | 036-046-108 (Illinois) | Secondary |
| 2080P0006X | Pediatrics - Developmental - Behavioral Pediatrics | 036-046-108 (Illinois) | Secondary |
| 2080P0008X | Pediatrics - Neurodevelopmental Disabilities | 036-046-108 (Illinois) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036-046-108 (Illinois) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 036-046-108 (Illinois) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Petronilo R Costa allows following entities to bill medicare on his behalf.
| Entity Name | Midwest Institute Of Neurological Discovery, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1881065738
PECOS PAC ID: 7214237981
Enrollment ID: O20151202000902 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Petronilo R Costa is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Petronilo R Costa, MD
420 Lake Cook Rd Ste 118,
Deerfield, IL 60015-4914
Ph: (847) 205-0237 | Petronilo R Costa, MD
420 Lake Cook Rd Ste 118,
Deerfield, IL 60015-4914
Ph: (847) 205-0237 |
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