Olubukola Komolafe, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP10975 Issued in AZ

Practice address

13838 S 46TH PL Ste 340
Phoenix, AZ 85044-7805

Phone

(832) 542-3181

NPI assigned

Feb 8, 2018

Last updated

Oct 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ, NV, OR3 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: olubukole.komolafe.p1@direct.cbridges.nextgenshare.com

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.

• Bethel Hills Intergrated Healthcare PLLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1578104154

  OR

  Medicare reassignment Authorized official
• District Medical Group, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Phoenix, AZ
  • NPI 1336472448

  Single Specialty

  Medicare reassignment NPD
• Good Health Medical, PLLC

  dba My Dr Now

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1144764432

  Single Specialty

  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  NV, OR, Single Specialty

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AZ, Single Specialty

  Medicare reassignment NPD
• Bethel Hills Integrated Healthcare

  dba Bethel Hills Clinic

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1215698642

  Psychiatric/Mental Health

  NPD (past) Authorized official
• Bethel Hills Integrated Healthcare

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1962155739
  NPD (past) Authorized official
• Bethel Hills Integrated Healthcare PLLC

  dba Bethel Hills Clinic

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1629676317
  NPD (past) Authorized official
• Bethel Hills Integrated Healthcare PLLC

  dba Bethel Hills Clinic

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1902491699
  NPD (past) Authorized official
• District Medical Group, Inc

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1144624339
  NPD
• District Medical Group, Inc

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1295968162

  Single Specialty

  NPD
• Good Health Medical, PLLC

  dba My Dr Now

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1023828431
  NPD

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1134628738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2251",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852522251",
            "telephone_number": "832-542-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13838 S 46TH PL STE 340",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850447805",
            "telephone_number": "832-542-3181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1810 E Sahara Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891043707",
            "country_code": "US",
            "telephone_number": "702-530-4531",
            "fax_number": "702-600-7123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOMOLAFE",
        "first_name": "OLUBUKOLA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-08",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP10975",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP10975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "451416",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina M Komara, MS
• Orest G Komarnyckyj, DDS
• Ivan Adrian Komerdelj, PHARMD
• Michelle Marie Kometh, LCSW
• Stephen Jeremy Kominsky, D.P.M.
• Linda Ellen Kompara, RKT
• Suzette Konakis, OT
• Frank G Konchan, M.D.
• Koustubh Kondapalli
• Jennfier Kondos

• Psychiatric/Mental Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.