George V Komaridis, PH.D.. LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP1673 Issued in MN

Practice address

11 Civic Center PLZ Ste 2090
Mankato, MN 56001-7710

Phone

(507) 345-4679

Fax

(507) 345-8685

NPI assigned

Feb 22, 2008

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

University of Nebraska College of Medicine, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Addictions and Stress Clinics LTDGroup PAC ID 3476790296, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Addictions and Stress Clinics LTD

  dba ASC Psychological Services

  • Psychologist
  • Mankato, MN
  • NPI 1376820118

  Clinical

  Medicare reassignment Care Compare group NPD
• Addictions & Stress Clinic

  dba ASC Psychological Services

  • Community/Behavioral Health Agency
  • Mankato, MN
  • NPI 1992085674
  NPD (past) Authorized official

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

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1124297213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CIVIC CENTER PLZ STE 205",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017718",
            "telephone_number": "507-345-4679",
            "fax_number": "507-345-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CIVIC CENTER PLZ STE 2090",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017710",
            "telephone_number": "507-345-4679",
            "fax_number": "507-345-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMARIDIS",
        "first_name": "GEORGE",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "PH.D.. LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-22",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP1673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin N Koehnen, DPT
• Ellen Kristine Koerner, OTR/L
• Meghan Kohler, LMFT
• Gabrielle Danae Kolles
• Jennifer Oline Kolstad, LICSW
• Lindsey Louise Konchar
• Alyce Lorayne Konz, LPN
• Rebecca Konz
• Tyler J Koonst, MD
• Naga Pradyumna Kothapalli, M.B.B.S.

• Clinical Psychologist in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.