Individual provider Active NPI

Tatum Thomas Komenda, PA-C

  • Physician Assistant
  • Gilbert, AZ
National Provider Identifier
1457085565
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10067 Issued in AZ
Practice address
3420 S Mercy Rd Ste 200
Gilbert, AZ 85297-0423
Phone
(480) 909-3788
Fax
(480) 728-8191
NPI assigned
Jul 13, 2022
Last updated
Oct 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 10067 AZ Primary
Surgical Physician Assistant 363AS0400X 10067 AZ

Addresses

Primary practice location

3420 S Mercy Rd Ste 200
Gilbert, AZ 85297-0423

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other practice location 1

500 W Thomas Rd Ste 800
Phoenix, AZ 85013-4217
Phone (602) 406-1234

Other names 1

  • Tatum Thomas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20231206002687 AZ Practitioner - Physician Assistant 3274982970 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians
Desert Orthopedics Center PLLCGroup PAC ID 7012279649, 10 clinicians

Practice addresses (Care Compare)

3420 S Mercy Rd
200 DHMG Specialty Medicine Mercy Gilbert
Gilbert, AZ 85297-0424
Phone (480) 909-3788

7301 E 2ND St
Suite 310
Scottsdale, AZ 85251-5627
Phone (877) 821-4657

7400 E Thompson Peak Pkwy
Scottsdale, AZ 85255-4109
Phone (877) 821-4657

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 2

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 3

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": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1457085565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 S MERCY RD STE 200",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970423",
            "telephone_number": "480-909-3788",
            "fax_number": "480-728-8191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Thomas Rd Ste 800",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134217",
            "country_code": "US",
            "telephone_number": "602-406-1234",
            "fax_number": "602-406-6368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOMENDA",
        "first_name": "TATUM",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "10067",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "10067",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TATUM",
            "last_name": "THOMAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.