Individual provider Active NPI

Steven Anthony Komadina, M.D.

  • Gynecology Physician
  • Albuquerque, NM
National Provider Identifier
1891794038
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
71-165 Issued in NM
Practice address
4801 McMahon Blvd NW
#101
Albuquerque, NM 87114-5090
Phone
(505) 893-2840
Fax
(505) 893-2844
NPI assigned
Jul 19, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 71-165 NM Primary

Addresses

Primary practice location

4801 McMahon Blvd NW
#101
Albuquerque, NM 87114-5090

Mailing address

4801 McMahon Blvd NW
#101
Albuquerque, NM 87114-5090
Phone (505) 893-2840

Other identifiers 1

IdentifierTypeStateIssuer
03244MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20120402000656 NM Practitioner - Obstetrics/Gynecology 7517127301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of New Mexico School of Medicine, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Womens Health Horizons, IncGroup PAC ID 7618137498, 10 clinicians

Practice addresses (Care Compare)

4801 McMahon Blvd NW
Suite 101
Albuquerque, NM 87114-5090
Phone (505) 893-2840

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71-165NMMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Womens Health Horizons, Inc CurrentSince Feb 4, 1966 Accepting new patients

Locations

4801 McMahon Blvd NW
Ste 101
Albuquerque, NM 87114
Phone (505) 269-7349

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292371200000",
    "number": "1891794038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 MCMAHON BLVD NW",
            "address_2": "#101",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145090",
            "telephone_number": "505-893-2840",
            "fax_number": "505-893-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 MCMAHON BLVD NW",
            "address_2": "#101",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145090",
            "telephone_number": "505-893-2840",
            "fax_number": "505-893-2844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMADINA",
        "first_name": "STEVEN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2010-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NM",
            "license": "71-165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03244",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.