Jeffrey C. Komenda, M.D., P.a.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

H6350 Issued in TX

Legal business name

JEFFREY C. KOMENDA, M.D., P.A.

Doing business as

Family Medicine at Willow Bend

Practice address

5944 W Parker Rd
Suite 100
Plano, TX 75093-6421

Phone

(972) 608-1868

Fax

(972) 943-8644

NPI assigned

Aug 31, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Craig Komenda, M.D.NPI 1396934865

Title

Medical Doctor

Phone

(972) 608-1868

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Family Medicine at Willow Bend Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Jeffrey C Komenda MD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Family Medicine at Willow Bend

  • Health Service Clinic/Center
  • Plano, TX
  • NPI 1174726061
  NPD tax ID
• Jeffrey C. Komenda, M.D., P.a.

  • Clinic/Center
  • Lewisville, TX
  • NPI 1972788628
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Jeffrey C. Komenda, M.D., P.a.

  • Clinic/Center
  • Lewisville, TX
  • NPI 1972788628
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Craig Komenda, M.D.

  • Family Medicine Physician
  • Plano, TX
  • NPI 1396934865

  Clinic/Center

  Medicare reassignment NPD Authorized official
• Saeid Davani, MD

  • Internal Medicine Physician
  • Plano, TX
  • NPI 1346999562
  Medicare reassignment NPD

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1003800434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5944 W PARKER RD",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750936422",
            "telephone_number": "972-608-1868",
            "fax_number": "972-943-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5944 W PARKER RD",
            "address_2": "SUITE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750936421",
            "telephone_number": "972-608-1868",
            "fax_number": "972-943-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY C. KOMENDA, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "KOMENDA",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "972-608-1868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "H6350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124934405",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165802302",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10018514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165802301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine at Willow Bend",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jalen Jefferson
• Shanda L Jefferson
• Kaela Lynette Jeffery
• Jeffrey Adelglass MD PA
• Jeffrey C Jaynes DDS PA
• Jeffrey F. Cattorini, M.D., P.a.
• Jeffrey J. Genato
• Jeffrey Longino Physical Therapy Services LLC
• Jeffrey Lue, MD PLLC
• Jeffrey M Adelglass MD and Associates PA

• Clinic/Center in Plano, TX
• Providers in Plano, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.