Individual provider Active NPI

Samuel Andrade

  • Family Medicine Physician
  • Aiea, HI
National Provider Identifier
1053002964
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MDR-8526 Issued in HI
Practice address
98-1005 Moanalua Rd SPC 3030
Aiea, HI 96701-4735
Phone
(808) 627-3200
NPI assigned
May 19, 2023
Last updated
May 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MDR-8526 HI Primary

Addresses

Primary practice location

98-1005 Moanalua Rd SPC 3030
Aiea, HI 96701-4735

Mailing address

98-1005 Moanalua Rd SPC 3030
Aiea, HI 96701-4735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MDR-8526HIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kapiolani Medical Specialists CurrentSince May 21, 2023 Accepting new patients
University Clinical Education & Research Associates PastSince May 21, 2023 Accepting new patients

Locations

98-1005 Moanalua Rd
Spc 3030
Aiea, HI 96701
Phone (808) 627-3200

Organizations & group practices 2

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": "1684454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1053002964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98-1005 MOANALUA RD SPC 3030",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-1005 MOANALUA RD SPC 3030",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014735",
            "telephone_number": "808-627-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRADE",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-19",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MDR-8526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

Verify at the official NPI Registry.