Individual provider Active NPI

Kemunto Mokaya, M.D.

  • Dermatology Physician
  • Conroe, TX
National Provider Identifier
1396065769
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
T5629 Issued in TX
Practice address
508 Medical Center Blvd Ste 380
Conroe, TX 77304-2954
Phone
(281) 573-8333
Fax
(936) 703-5323
NPI assigned
Jun 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD0000051717 TN
Pediatric Dermatology Physician 207NP0225X T5629 TX
Pediatric Dermatology Physician 207NP0225X MD0000051717 TN
Procedural Dermatology Physician 207NS0135X 207NS0135X TX
Procedural Dermatology Physician 207NS0135X MD000051717 TN
Dermatology Physician 207N00000X T5629 TX Primary

Addresses

Primary practice location

508 Medical Center Blvd Ste 380
Conroe, TX 77304-2954

Mailing address

508 Medical Center Blvd Ste 380
Conroe, TX 77304-2954
Phone (281) 573-8333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20220510001650 TX Practitioner - Dermatology 9335370634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Yale University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael Sonabend MD PAGroup PAC ID 6901045665, 28 clinicians

Practice addresses (Care Compare)

508 Medical Ctr Blvd
Suite 380
Conroe, TX 77304-2954
Phone (281) 240-4313

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision13
Removal of skin lesions1113
Removal or shaving of skin growth169
Skin biopsy65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD000051717TNMDProcedural Dermatology Physician
207NS0135XTXMDProcedural Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michael Sonabend M.D., P.a. Dermatology CurrentSince Jun 1, 2022 Accepting new patients
Complete Labs PLLC Current Accepting new patients
Skinner Dermatology and Mohs Surgery Dermatology Past Accepting new patients

Locations

17191 St Lukes Way
Ste 210
Conroe, TX 77384
Phone (281) 573-8333

508 Medical Center Blvd
Ste 380
Conroe, TX 77304
Phone (281) 240-4313

134 Vision Park Blvd
Ste 200
Shenandoah, TX 77384
Phone (281) 573-8333

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1396065769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 MEDICAL CENTER BLVD STE 380",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042954",
            "telephone_number": "281-573-8333",
            "fax_number": "936-703-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 MEDICAL CENTER BLVD STE 380",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042954",
            "telephone_number": "281-573-8333",
            "fax_number": "936-703-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOKAYA",
        "first_name": "KEMUNTO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-08",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "MD0000051717",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "TX",
            "license": "T5629",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "TN",
            "license": "MD0000051717",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TX",
            "license": "207NS0135X",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TN",
            "license": "MD000051717",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "T5629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.