Active NPI
Samuel Andrade
- Family Medicine Physician
- Aiea, HI
National Provider Identifier
1053002964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MDR-8526
- 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, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR-8526 | HI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kapiolani Medical Specialists | Current | Accepting new patients | |
| University Clinical Education & Research Associates | Past | 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.
-
dba Hawaii Pacific Health Medical Group
- Multi-Specialty Clinic/Center
- Honolulu, HI
- NPI 1124071014
-
dba University Health Partners of Hawaii
- Clinical Medical Laboratory
- Honolulu, HI
- NPI 1659971489
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.