Tessa Komine, MS, RDN, LD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD-D-10188211 Issued in OR

Practice address

2100 NE Broadway St Ste 225
Portland, OR 97232

Phone

(971) 270-0590

Fax

(971) 255-1754

NPI assigned

Oct 11, 2016

Last updated

Oct 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2020 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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.

• Fearless With Food, LLC

  • Registered Dietitian
  • Portland, OR
  • NPI 1174166441
  Authorized official Same address or phone

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1396295580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 NE BROADWAY ST STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321544",
            "telephone_number": "971-270-0590",
            "fax_number": "971-255-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 NE BROADWAY ST STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97232",
            "telephone_number": "971-270-0590",
            "fax_number": "971-255-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMINE",
        "first_name": "TESSA",
        "credential": "MS, RDN, LD, CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-11",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10188211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Kolton, PT, DPT
• Sergey Komarov
• Anna Jordan Komer, PT, DPT, OLS
• Radko Komers, M.D.
• Anastasia Elizabeth-Rios Komfolio
• Cameron James Komisar, ND
• Jeffrey Aaron Komisarof, MD
• Christopher Komisarz, DO, MPH
• Kari Michelle Komlofske, FNP-C
• Alexander Kondra

• Registered Dietitian in Portland, OR
• Providers in Portland, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.