Bethel Hills Integrated Healthcare PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BETHEL HILLS INTEGRATED HEALTHCARE PLLC

Practice address

13838 S 46TH PL Ste 340
Phoenix, AZ 85044-7805

Phone

(832) 542-3181

NPI assigned

Mar 4, 2021

Organization subpart

No

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

Authorized official

Name

Olubukola Komolafe, DNP, PMHNP-BC, FNP-BNPI 1134628738

Title

Medical Director

Phone

(832) 542-3181

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Bethel Hills Clinic Doing business as

Electronic endpoints 1

Tax ID family

Bethel Hills Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Bethel Hills Integrated Healthcare

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1215698642
  NPD tax ID
• Bethel Hills Integrated Healthcare

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1962155739
  NPD tax ID
• Bethel Hills Integrated Healthcare PLLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1629676317
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Olubukola Komolafe, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1134628738
  NPD (past) Authorized official

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1902491699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13838 S 46TH PL STE 340",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850447805",
            "telephone_number": "832-542-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13838 S 46TH PL STE 340",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850447805",
            "telephone_number": "832-542-3181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13838 S 46th Pl Ste 300",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850447804",
            "country_code": "US",
            "telephone_number": "832-542-3181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BETHEL HILLS INTEGRATED HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "KOMOLAFE",
        "authorized_official_first_name": "OLUBUKOLA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "832-542-3181",
        "authorized_official_credential": "DNP, PMHNP-BC, FNP-B"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606122",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084714",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "admin@bethelhillsintegrated.com",
            "affiliation": "N",
            "address_1": "13838 S 46th Pl Ste 340",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850447805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bethel Hills Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Womens Healthcare, P.C.
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• Bethel Hills Integrated Healthcare
• Bethel Hills Integrated Healthcare
• Bethel Hills Integrated Healthcare PLLC
• Bethel Homes LLC
• Bethesda Foundation
• Mark James Espinosa Betonio, MD
• Mary Betsellie, CPM
• Stacy E Bettelon, LAC

• Psychiatric/Mental Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; 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.