NPIMap

Individual provider Active NPI

Komal Patil-Sisodia, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Baltimore, MD
National Provider Identifier
1730325010
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
D70322 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(410) 706-6474
Fax
(410) 706-0231
NPI assigned
Dec 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X D70322 MD Primary

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

PO Box 64442
Baltimore, MD 21264-4443
Phone (410) 706-6474

Other identifiers 3

IdentifierTypeStateIssuer
S062-0447OtherMDCAREFIRST BC/BS REGIONAL
444103600MedicaidMD
975348-01 & 02OtherMDCAREFIRST BC/BS

Other names 1

  • Dr. Komal Shashikant Patil Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141106000398 WA Practitioner - EndocrinologyPractitioner - Cardiovascular Disease (Cardiology) 8325188485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Albany Medical College of Union University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

8980 161St Ave NE
Suite 400
Redmond, WA 98052-7554
Phone (425) 899-6414

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D70322MDMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No. 2 CurrentSince Jul 2, 2014 Accepting new patients
King County Public Hospital District No 2 CurrentSince Jul 2, 2014 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No. 2 Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients

Locations

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

12040 NE 128th St
#50
Kirkland, WA 98034
Phone (425) 899-1894

12333 NE 130th Ln
Ste 400
Kirkland, WA 98034
Phone (425) 216-4220

8980 161st Ave NE
Ste 400
Redmond, WA 98052
Phone (425) 883-3404

Organizations & group practices 7

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.

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": "1229472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320883200000",
    "number": "1730325010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64442",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644443",
            "telephone_number": "410-706-6474",
            "fax_number": "410-706-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-706-6474",
            "fax_number": "410-706-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATIL-SISODIA",
        "first_name": "KOMAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-17",
        "last_updated": "2011-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MD",
            "license": "D70322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS REGIONAL",
            "identifier": "S062-0447",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444103600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS",
            "identifier": "975348-01 & 02",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KOMAL",
            "last_name": "PATIL",
            "middle_name": "SHASHIKANT",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.