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JACK M. COSTA, M.D., P.C.
NPI 1972808335
Specialist in Fairfax, VA

Active since January 17, 2011
3650 JOSEPH SIEWICK DR, SUITE 202, FAIRFAX, VA 22033(703) 391-2516(703) 476-8244 Get Directions Write a Review

NPPES record last updated: January 17, 2011. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jack M. Costa, M.d., P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK M. COSTA, M.D., P.C. (NPI 1972808335) is a healthcare organization registered as a specialist in Fairfax, Virginia and active in the NPI registry since January 2011. The organization lists Jack M. Costa, Owner, as its authorized official.

NPPES Registry Identity

NPI1972808335
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameJACK M. COSTA, M.D., P.C.
Location Address3650 JOSEPH SIEWICK DR, SUITE 202Fairfax, VA 22033-1710
Mailing Address3650 Joseph Siewick Dr, Suite 202Fairfax, VA 22033-1710 · (703) 391-2516 · Fax (703) 476-8244
Phone(703) 391-2516
Fax(703) 476-8244
Organization SubpartNo
Authorized OfficialJack M. CostaOwner · (703) 391-2516
Enumeration DateJanuary 17, 2011
✔ NPI 1972808335 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in VA · 0101028288
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
3650 JOSEPH SIEWICK DR, Fairfax, VA 22033
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Other Identifiers 4

Medicare UPINC62572
Other003539VA · Anthem
Medicare PIN409274
Other9320VA · Blue Cross Blue Shield

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack M. Costa, M.d., P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jack M. Costa, M.D., P.C., which bills Medicare for the services this clinician delivers.

Clinician (1)

Jack Costa, M.D.
Dermatology
NPI 1144393935
3650 JOSEPH SIEWICK DR SUITE 202
Fairfax, VA 22033
(703) 391-2516
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack M. Costa, M.D., P.C.'s NPI number?

The NPI number for Jack M. Costa, M.D., P.C. is 1972808335. It was assigned to this organization in the NPPES registry on January 17, 2011.

Where is Jack M. Costa, M.D., P.C. located?

Jack M. Costa, M.D., P.C. is located at 3650 Joseph Siewick Dr Suite 202, Fairfax, VA 22033. The listed phone number is (703) 391-2516.

What is Jack M. Costa, M.D., P.C.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Jack M. Costa, M.D., P.C. enrolled in Medicare?

Yes. Jack M. Costa, M.D., P.C. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jack M. Costa, M.D., P.C.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Jack M. Costa, M.D., P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Jack M. Costa, M.D., P.C. was last updated on January 17, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.