OrganizationActiveAccepts Medicare
Jack M. Costa, M.D., P.C.
NPI 1972808335 · Specialist · Fairfax, VA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1972808335
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Jack Costa, Owner(703) 391-2516
- License
- 0101028288 (VA)
Specialties & taxonomies
Other Service Providers
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3650 Joseph Siewick Dr
Suite 202
Fairfax, VA 22033-1710
Phone: (703) 391-2516
Fax: (703) 476-8244
Street-level locationGet directions
Mailing address
3650 Joseph Siewick Dr
Fairfax, VA 22033-1710
Registry dates
- Enumerated
- 2011-01-17
- Last updated
- 2011-01-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.