Individual provider Active NPI

Imtiaz Hussain Bangash, MD

  • Hospitalist Physician
  • Honolulu, HI
National Provider Identifier
1003216953
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD-24060 Issued in HI
Practice address
1301 Punchbowl St
Honolulu, HI 96813-2499
Phone
(808) 691-1000
NPI assigned
Aug 28, 2014
Last updated
Feb 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X CDR.0002708 KS
Hospitalist Physician 208M00000X 036143032 IL
Hospitalist Physician 208M00000X MD-24060 HI Primary

Addresses

Primary practice location

1301 Punchbowl St
Honolulu, HI 96813-2499

Mailing address

1301 Punchbowl St
Honolulu, HI 96813-2499
Phone (808) 691-1000

Other practice location 1

1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-5811

Other practice location 2

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 257-6220

Other practice location 3

401 E Spruce St
Garden City, KS 67846-5679
Phone (620) 272-2222

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ibangash157628@ewd.direct.hshs.org Direct
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, VI, HI3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20170509001464 IL Practitioner - HospitalistPractitioner - Internal Medicine 4688951288 Reassigns benefits to 1 organization
I20230424002878 VI Practitioner - Internal Medicine 4688951288 Reassigns benefits to 1 organization
I20240117003467 HI Practitioner - General Practice 4688951288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians
Midpacific Hospitalists LLCGroup PAC ID 9335439926, 12 clinicians

Practice addresses (Care Compare)

1301 Punchbowl St
Honolulu, HI 96813-2499

1380 Lusitana St
Honolulu, HI 96813-2448

67-1125 Mamalaho Hwy
Kamuela, HI 96743-8496
Phone (808) 885-4444

91 -2127 Fort Weaver Rd
Ewa Beach, HI 96706-1993
Phone (808) 691-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CDR.0002708KSMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midpacific Hospitalists LLC CurrentSince Oct 25, 2024 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Jun 1, 2023 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Jun 1, 2023 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Apr 10, 2023 Accepting new patients
Queens University Medical Group CurrentSince Jan 4, 2024 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Apr 10, 2023 Accepting new patients
Queens North Hawaii Community Hospital Past Accepting new patients
Hawaii Emergency Physicians Associated Inc Past Accepting new patients

Locations

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

67-1125 Mamalahoa Hwy
Kamuela, HI 96743
Phone (808) 881-4400

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423

Networks

  • IL PPO Downstate
  • devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
  • IL HMO C-SNP
  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

Interoperability endpoints

  • Direct secure messaging: ibangash157628@ewd.direct.hshs.org

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1003216953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PUNCHBOWL ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132499",
            "telephone_number": "808-691-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PUNCHBOWL ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132499",
            "telephone_number": "808-691-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 E Lake Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625213810",
            "country_code": "US",
            "telephone_number": "217-464-5811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622265360",
            "country_code": "US",
            "telephone_number": "618-257-6220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 E Spruce St",
            "address_purpose": "LOCATION",
            "city": "Garden City",
            "state": "KS",
            "postal_code": "678465679",
            "country_code": "US",
            "telephone_number": "620-272-2222",
            "fax_number": "620-272-2755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANGASH",
        "first_name": "IMTIAZ",
        "middle_name": "HUSSAIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-28",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "KS",
            "license": "CDR.0002708",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036143032",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "HI",
            "license": "MD-24060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ibangash157628@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1800 E Lake Shore Dr",
            "city": "Decatur",
            "state": "IL",
            "country_code": "US",
            "postal_code": "625213810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4500 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.