Jeffrey C. Komenda, M.D., P.a.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

H6350 Issued in TX

Legal business name

JEFFREY C. KOMENDA, M.D., P.A.

Practice address

1305 S SH 121
Ste C-108
Lewisville, TX 75067-5915

Phone

(972) 608-1868

Fax

(972) 943-8644

NPI assigned

Dec 31, 2007

Last updated

Aug 11, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

JEFFREY C. KOMENDA, M.D., P.A.As reported in NPPES

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

Authorized official

Name

Mrs. Tammy Tickle Komenda

Title

Office Manager

Phone

(972) 608-1868

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Best Choice Medical Clinic Other name

Tax ID family

Jeffrey C Komenda MD3 organizations share this tax ID, including this one

Part of

Jeffrey C Komenda MD

Other organizations with this tax ID 2

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

• Family Medicine at Willow Bend

  • Health Service Clinic/Center
  • Plano, TX
  • NPI 1174726061
  NPD tax ID
• Jeffrey C. Komenda, M.D., P.a.

  dba Family Medicine at Willow Bend

  • Clinic/Center
  • Plano, TX
  • NPI 1003800434
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Jeffrey C. Komenda, M.D., P.a.

  dba Family Medicine at Willow Bend

  • Clinic/Center
  • Plano, TX
  • NPI 1003800434
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Craig Komenda, M.D.

  • Family Medicine Physician
  • Plano, TX
  • NPI 1396934865

  Clinic/Center

  NPD (past)

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1972788628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5944 W PARKER RD STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750936422",
            "telephone_number": "972-608-1868",
            "fax_number": "972-943-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 S SH 121",
            "address_2": "STE C-108",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750675915",
            "telephone_number": "972-608-1868",
            "fax_number": "972-943-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY C. KOMENDA, M.D., P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFREY C. KOMENDA, M.D., P.A.",
        "enumeration_date": "2007-12-31",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "KOMENDA",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "TICKLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "972-608-1868",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "H6350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS INDIVIDUAL",
            "identifier": "8AJ618",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165802301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS  GROUP NUMBER",
            "identifier": "0007QN",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10018514",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID HEALTH STEPS",
            "identifier": "165802302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Best Choice Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jason Jorgensen, DO, PLLC
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• Veronica Javier-Vong, PT, DPT
• JB Counseling & Wellness PLLC
• Rachel Ann Jeffords, MS CCC SLP
• George Jeha, MD
• Britany Rae Jenkins
• Jinseon Jeong, OD
• Jesus Take the Wheel, LLC
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• Clinic/Center in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; 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.