Individual provider Active NPI

Marissa Helene Fakaosita, MD

  • Pediatrics Physician
  • Honolulu, HI
National Provider Identifier
1003178971
Registry record updated Jun 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
18143 Issued in HI
Practice address
1319 Punahou St FL 7
Honolulu, HI 96826-1001
Phone
(808) 369-1200
NPI assigned
Jun 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R73239 AZ
Pediatrics Physician 208000000X 18143 HI Primary

Addresses

Primary practice location

1319 Punahou St FL 7
Honolulu, HI 96826-1001

Mailing address

1319 Punahou St FL 7
Honolulu, HI 96826-1001
Phone (808) 369-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
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
I20140905000233 HI Practitioner - HospitalistPractitioner - Pediatric Medicine 9234357138 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R73239AZMDPediatrics Physician
18143HIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kapiolani Medical Specialists CurrentSince Jul 11, 2015 Accepting new patients
Kapiolani Medical Center for Women & Children Past Accepting new patients

Locations

1319 Punahou St
Honolulu, HI 96826
Phone (808) 485-4300

1319 Punahou St
Fl 7
Honolulu, HI 96826
Phone (808) 369-1200

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433808000000",
    "number": "1003178971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 PUNAHOU ST FL 7",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968261001",
            "telephone_number": "808-369-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 PUNAHOU ST FL 7",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968261001",
            "telephone_number": "808-369-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAKAOSITA",
        "first_name": "MARISSA",
        "middle_name": "HELENE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-15",
        "last_updated": "2015-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "R73239",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "HI",
            "license": "18143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.