NPIMap

Organization Active NPI

Samuel Mahelona Memorial Hospital

Doing business as HHSC - Kauai Region Clinics Urgent Care at Poipu

  • Rural Health Clinic/Center
  • Koloa, HI
National Provider Identifier
1033705074
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Doing business as
HHSC - Kauai Region Clinics Urgent Care at Poipu
Practice address
2829 Ala Kalani Kaumaka St Ste B-201
Koloa, HI 96756-7549
Phone
(808) 742-0999
Fax
(808) 742-0990
NPI assigned
Dec 14, 2020
Last updated
May 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SAMUEL MAHELONA MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Christine Marie Asato
Title
Regional Cfo
Phone
(808) 338-9407

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2829 Ala Kalani Kaumaka St Ste B-201
Koloa, HI 96756-7549

Mailing address

PO Box 337
Waimea, HI 96796-0337
Phone (808) 338-9431

Other names 1

  • HHSC - Kauai Region Clinics Urgent Care at Poipu Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040318000116 HI Part B Supplier - Clinic/Group Practice 1759271216 Receives reassigned benefits from 69 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lihue, HI; Waimea, HI; Koloa, HI; Kapaa, HI; Kalaheo, HI; Eleele, HI
O20210204002793 HI Part A Provider - Rural Health Clinic 1759271216 Practice locations: Koloa, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033705074. Details of each certification follow.

Rural health clinic certification: CCN 123992

Legal name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Doing business as
HHSC - KAUAI REGION CLINICS URGENT CARE AT POIPU
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 12, 2021
Last certification
Oct 12, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
2829 Ala Kalani Kaumaka St
Ste B201 - Unit B
Koloa, HI 96756-7549
Related CCNs
121306

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D2219111HHSC Kauai Region Clinics Urgent Care at Poipu2829 Ala Kalanikaumaka St B-201, Unit B, Koloa, HI 96756Provider-performed microscopyMar 31, 2027

National Provider Directory

National Provider Directory
Part of
Samuel Mohelona Memorial

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Samuel Mahelona Memorial Hospital Organization, Kapaa, HI 5% Or Greater Direct Ownership Interest Dec 23, 2020 95%
Lance K Segawa Individual Corporate OfficerRegional Ceo Apr 1, 2018 100%
W-2 Managing EmployeeRegional Ceo Apr 1, 2018 100%
Operational/Managerial ControlRegional Ceo Apr 1, 2018 100%
Rhonelle Aceret Individual W-2 Managing EmployeeCredentialing Coordinator Dec 17, 2018
Laurel K S Loo Individual Corporate DirectorBoard Member May 17, 2017
Tito Villanueva Individual Corporate DirectorBoard Member May 17, 2017
Donna Okada-Asher Individual Corporate DirectorBoard Member May 17, 2017
Patrick S Gegen Individual Corporate DirectorBoard Member May 17, 2017
Hawaii Health Systems Corporation Organization, Honolulu, HI Corporation 5% Or Greater Direct Ownership Interest Dec 23, 2020 5%
Stephanie N Iona Individual Corporate DirectorBoard Member May 15, 2017
Christine M Asato Individual Corporate OfficerRegional Cfo Apr 1, 2018 50%
W-2 Managing EmployeeRegional Cfo Apr 1, 2018 50%
Operational/Managerial Control Apr 1, 2018 50%

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 12Z306 Hospital 5% Or Greater Direct Ownership Interest (95%) Jul 1, 1996
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 12M306 Hospital 5% Or Greater Direct Ownership Interest (25%)
Operational/Managerial Control (25%)		 Jan 29, 2010
Jan 29, 2010
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 125029 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 17, 2017
Apr 1, 2015
HHSC - Kauai Region Clinics the Clinic at Port AllenEleele, HI, CCN 123989 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at KapaaKapaa, HI, CCN 123988 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Specialty Clinic at KalaheoKalaheo, HI, CCN 123987 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at KalaheoKalaheo, HI, CCN 123986 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at LihueLihue, HI, CCN 123985 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at WaimeaWaimea, HI, CCN 123990 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 36

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 36

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1033705074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 337",
            "city": "WAIMEA",
            "state": "HI",
            "postal_code": "967960337",
            "telephone_number": "808-338-9431",
            "fax_number": "808-338-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 ALA KALANI KAUMAKA ST STE B-201",
            "city": "KOLOA",
            "state": "HI",
            "postal_code": "967567549",
            "telephone_number": "808-742-0999",
            "fax_number": "808-742-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL MAHELONA MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAMUEL MAHELONA MEMORIAL HOSPITAL",
        "enumeration_date": "2020-12-14",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "ASATO",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "REGIONAL CFO",
        "authorized_official_telephone_number": "808-338-9407"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HHSC - Kauai Region Clinics Urgent Care at Poipu",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HHSC - Kauai Region Clinics Urgent Care at Poipu",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Koloa, HI

Sources for this page

Verify at the official NPI Registry.