NPIMap

Organization Active NPI

Family Medicine at Willow Bend

  • Health Service Clinic/Center
  • Plano, TX
National Provider Identifier
1174726061
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
H6350 Issued in TX
Legal business name
FAMILY MEDICINE AT WILLOW BEND
Practice address
5944 W Parker Rd Ste 100
Plano, TX 75093-6422
Phone
(972) 608-1868
Fax
(972) 943-8644
NPI assigned
Jun 7, 2007
Last updated
Aug 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

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

Authorized official

Name
Tammy Tickle Komenda
Title
Office Manager
Phone
(972) 608-1868

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X H6350 TX Primary

Addresses

Primary practice location

5944 W Parker Rd Ste 100
Plano, TX 75093-6422

Mailing address

5944 W Parker Rd Ste 100
Plano, TX 75093-6422
Phone (972) 608-1868

Other identifiers 3

IdentifierTypeStateIssuer
10018514OtherTXAMERIGROUP PROVIDER #
165802301MedicaidTX
65802302MedicaidTX

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1174726061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5944 W PARKER RD STE 100",
            "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 STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750936422",
            "telephone_number": "972-608-1868",
            "fax_number": "972-943-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE AT WILLOW BEND",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "KOMENDA",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "TICKLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "972-608-1868"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "TX",
            "license": "H6350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP PROVIDER #",
            "identifier": "10018514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165802301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65802302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.