NPIMap

Organization Active NPI

Imua Health Group, LLC

  • Psychologist
  • Aiea, HI
National Provider Identifier
1023648995
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
IMUA HEALTH GROUP, LLC
Practice address
99-080 Kauhale St Ste C20
Aiea, HI 96701-4114
Phone
(808) 953-4682
NPI assigned
Jan 20, 2020
Last updated
Jan 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Authorized official

Name
Travis Purdy
Title
Cfo
Phone
(808) 953-4682

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU Primary
Clinical Social Worker 1041C0700X NU
Acupuncturist 171100000X NU

Addresses

Primary practice location

99-080 Kauhale St Ste C20
Aiea, HI 96701-4114

Mailing address

99-080 Kauhale St Ste C20
Aiea, HI 96701-4114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200312001868 HI Part B Supplier - Clinic/Group Practice 4082042650 Receives reassigned benefits from 33 practitioners
Practice locations: Aiea, HI; Kaneohe, HI

National Provider Directory

National Provider Directory

Locations

841 Bishop St
Ste 1608
Honolulu, HI 96813
Phone (808) 734-3904

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1579478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1023648995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99-080 KAUHALE ST STE C20",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99-080 KAUHALE ST STE C20",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014114",
            "telephone_number": "808-953-4682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMUA HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-20",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "PURDY",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "808-953-4682"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.