Individual provider Active NPI

Michael Stephen Comisac III, DO

  • Family Medicine Physician
  • Berlin, NH
National Provider Identifier
1053008367
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
EL33986 Issued in NH
Practice address
133 Pleasant St
Berlin, NH 03570-2006
Phone
(603) 752-2040
NPI assigned
Apr 18, 2023
Last updated
Jun 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X EL33986 NH Primary

Addresses

Primary practice location

133 Pleasant St
Berlin, NH 03570-2006

Mailing address

133 Pleasant St
Berlin, NH 03570-2006
Phone (603) 752-2040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250612004184 ID Practitioner - Family Practice 7719341957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

1919 Lincoln Way
Suite 315
Coeur D Alene, ID 83814-2527
Phone (208) 625-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
EL33986NHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. Current Accepting new patients
Kootenai Health, Inc. CurrentSince Apr 22, 2025 Accepting new patients
Kootenai Health, Inc. CurrentSince Apr 22, 2025 Accepting new patients

Locations

1919 Lincoln Way
Ste 315
Coeur D Alene, ID 83814
Phone (208) 625-6000

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

Organizations & group practices 3

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1053008367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 PLEASANT ST",
            "city": "BERLIN",
            "state": "NH",
            "postal_code": "035702006",
            "telephone_number": "603-752-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 PLEASANT ST",
            "city": "BERLIN",
            "state": "NH",
            "postal_code": "035702006",
            "telephone_number": "603-752-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMISAC",
        "first_name": "MICHAEL",
        "middle_name": "STEPHEN",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-18",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "EL33986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, NH

Sources for this page

Verify at the official NPI Registry.