Revati Komandur, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9601650 Issued in NC

Practice address

2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001

Phone

(910) 907-8922

Fax

(910) 907-8922

NPI assigned

May 23, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cumberland County Hospital System Inc

  • Diagnostic Radiology Physician
  • Fayetteville, NC
  • NPI 1962299743
  NPD (past)
• Heritage Family Physicians

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1003818485
  NPD (past)

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1023012358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVENUE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-8922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMANDUR",
        "first_name": "REVATI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-23",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9601650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8910213",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Ross Kobialka, PA
• James L Koehler Jr., DMD
• Chad A Koenig
• Peter Christopher Koepp, PA-C
• Jordann Kokoski, DO
• John Komas
• Bradley Joseph Komrowski-Poppen, PHD
• John Victor Korby, FNP
• Dawn Korcz
• Rita A Kostecke, MD, MPH

• Internal Medicine Physician in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.