NPIMap

Individual provider Active NPI

Irina Komarova, M.D.

  • Hospitalist Physician
  • Lakewood, WA
National Provider Identifier
1194038851
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD60257711 Issued in WA
Practice address
11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Phone
(253) 426-6341
Fax
(253) 426-6344
NPI assigned
Jul 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD60257711 WA Primary
Internal Medicine Physician 207R00000X 60257711 WA

Addresses

Primary practice location

11315 Bridgeport Way SW
Lakewood, WA 98499-3004

Mailing address

11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Phone (253) 426-6341

Other identifiers 1

IdentifierTypeStateIssuer
2020164MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ikomarova769690@fhsce.catholichealth.net Direct Franciscan Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121009000738 WA Practitioner - HospitalistPractitioner - Internal Medicine 4688823552 Reassigns benefits to 1 organization
I20150629000467 PA Practitioner - Internal Medicine 4688823552 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Phone (253) 426-6341

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60257711WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Internal Medicine CurrentSince Nov 14, 2022 Accepting new patients
Apogee Medical Group of Pennsylvania PC Internal Medicine CurrentSince Jun 1, 2015 Accepting new patients
Steward Medical Group Inc. Internal Medicine Current Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 5, 2020 Accepting new patients
Franciscan Medical Group CurrentSince Nov 14, 2022 Accepting new patients
Apogee Medical Group of Pennsylvania PC Internal Medicine CurrentSince Jun 1, 2015 Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 5, 2020 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Saint Clare Hospital Past Accepting new patients

Locations

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

763 Johnsonburg Rd
Saint Marys, PA 15857
Phone (814) 788-8000

740 E State St
Sharon, PA 16146
Phone (724) 983-1980

951 Male Rd
Wind Gap, PA 18091
Phone (610) 654-1000

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

11315 Bridgeport Way SW
Tacoma, WA 98499
Phone (253) 588-1711

Organizations & group practices 9

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 5

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": "1279756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1194038851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11315 BRIDGEPORT WAY SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984993004",
            "telephone_number": "253-426-6341",
            "fax_number": "253-426-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11315 BRIDGEPORT WAY SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984993004",
            "telephone_number": "253-426-6341",
            "fax_number": "253-426-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMAROVA",
        "first_name": "IRINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-22",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD60257711",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "60257711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2020164",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikomarova769690@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11315 Bridgeport Way SW",
            "city": "Lakewood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984993004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.