Individual provider Active NPI

Robert Canonico, DO

  • Emergency Medicine Physician
  • Aiea, HI
National Provider Identifier
1003956905
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
807 Issued in HI
Practice address
98-1079 Moanalua Rd
Aiea, HI 96701-4713
Phone
(330) 493-4443
NPI assigned
Feb 8, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 807 HI Primary

Addresses

Primary practice location

98-1079 Moanalua Rd
Aiea, HI 96701-4713

Mailing address

4535 Dressler Rd NW
Canton, OH 44718-2545
Phone (330) 493-4443

Other identifiers 1

IdentifierTypeStateIssuer
208705MedicaidHI

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
I20041122000462 HI Practitioner - Emergency Medicine 0143285981 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.94 of 100Reported as group
Quality
94.24
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
807HIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Honolulu Pali Momi, LLC Emergency Medicine CurrentSince Jan 1, 2011 Accepting new patients
Emergency Medicine Physicians of Honolulu Kapiolani, LLC Emergency Medicine CurrentSince Jul 6, 2014 Accepting new patients
Hawaii Emergency Physicians Associated Inc Emergency Medicine CurrentSince Mar 2, 2024 Accepting new patients
Midpacific Hospitalists LLC Past Accepting new patients
Emergency Physicians Medical Group, Inc Emergency Medicine Past Accepting new patients

Locations

98-1079 Moanalua Rd
Aiea, HI 96701
Phone (808) 485-4301

1190 Waianuenue Ave
Hilo, HI 96720
Phone (808) 932-3000

45-547 Plumeria St
Honokaa, HI 96727
Phone (808) 932-4100

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

640 Ulukahiki St
Kailua, HI 96734
Phone (808) 261-3326

4535 Dressler Rd NW
Canton, OH 44718
Phone (330) 994-4409

Organizations & group practices 5

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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003956905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-1079 MOANALUA RD",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014713",
            "telephone_number": "330-493-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANONICO",
        "first_name": "ROBERT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208705",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

Verify at the official NPI Registry.