Julia Anne Mandsager Komatsu

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

1015865 Issued in MA

Practice address

2207 Boston Road
Wilbraham, MA 01095

Phone

(413) 599-1201

Fax

(413) 596-2940

NPI assigned

Apr 5, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jkomatsu37314@direct.chppoc.masshiway.net

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.

• George F Vitek MD & Associates PC

  • Pediatric Adolescent Medicine Physician
  • Wilbraham, MA
  • NPI 1457393506
  NPD (past)

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

{
    "created_epoch": "1586044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1811526494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 BOSTON ROAD",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "01095",
            "telephone_number": "413-599-1201",
            "fax_number": "413-596-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 BOSTON ROAD",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "01095",
            "telephone_number": "413-599-1201",
            "fax_number": "413-596-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDSAGER KOMATSU",
        "first_name": "JULIA",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-05",
        "last_updated": "2023-11-20",
        "certification_date": "2020-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MA",
            "license": "1015865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110201385A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Levy, LABA, BCBA
• Janie Lynn Lizak, MS CCC-SLP
• Margaret Loughman, PA-C, ATC
• Lori A Lyne, NP
• Priya Sharma Malik, M.D., M.P.H
• Sara Marcotte
• Maureen Q Margolis
• Michael Jonathan Margolis, D.D.S., PH.D.
• Kaitlyn Sullivan Martin, LICSW
• Joeenthonie Martinez

• Pediatric Adolescent Medicine Physician in Wilbraham, MA
• Providers in Wilbraham, MA by specialty
• Pediatric Adolescent Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.