Integrated Care LLC
Organization Active NPI Family Nurse Practitioner · Aiea, HI
NPI 1053036798 · NPPES record last updated May 10, 2023
Key facts
- NPI
- 1053036798
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- INTEGRATED CARE LLC
- Practice address
- 98-871 Kaonohi St Unit 57D
Aiea, HI 96701-2458 - Phone
- (808) 738-7671
- NPI assigned
- Oct 5, 2022
- Organization subpart
- No
Authorized official
- Name
- Thomas Andersen
- Title
- Owner
- Phone
- (808) 738-7671
Practitioners 4
-
Raquiel Andersen, DNP, FNP-C, PMHNP-C
-
Carissa Manreal Bolo, NURSE PRACTITIONER
-
Azal Lopez, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in HI, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230614000734 | HI | Part B Supplier - Clinic/Group Practice | 1355709973 |
Receives reassigned benefits from 4 practitioners Practice locations: Ewa Beach, HI; Honolulu, HI; Wailuku, HI |
| O20260226004370 | AZ | Part B Supplier - Clinic/Group Practice | 1355709973 |
Receives reassigned benefits from 1 practitioner Practice locations: Sierra Vista, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
98-871 Kaonohi St Unit 57D
Aiea, HI 96701-2458
Mailing address
98-871 Kaonohi St Unit 57D
Aiea, HI 96701-2458
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- Insight Psychological Services LLC
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All providers in Aiea, HI · Family Nurse Practitioner in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.