JACK MICHAEL COSTA (M.D.) – Dermatology Physician, NPI 1144393935
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
471 DERMATOLOGY in VA
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Provider Addresses for JACK MICHAEL COSTA (M.D.)
Fair Oaks Professional Building, 3650, Joseph Siewick Drive, Chantilly, Fairfax (city), Virginia, 22033, United States
SUITE 202
FAIRFAX, VA 220331710
Phone: (703) 391-2516
Fax: (703) 476-8244
Type: Location
Fair Oaks Professional Building, 3650, Joseph Siewick Drive, Chantilly, Fairfax County, Virginia, 22033, United States
SUITE 202
FAIRFAX, VA 22033
Phone: (703) 391-2516
Fax: (703) 476-8244
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2011-04-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110415000235 | I | Dermatology | DC | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 483 | 101 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 266 | 149 | $0 |
| 11104 | Punch biopsy, first skin growth | 222 | 142 | $0 |
| 27323 | Biopsy of surface tissue of thigh or knee | 194 | 86 | $0 |
| 27613 | Biopsy of surface tissue of leg or ankle | 188 | 91 | $0 |
Insurance plans in this area (ZIP 22033)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | VA | 11101 | Biopsy of each additional growth of skin and/or tissue | 107 | 70 |
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