NPIMap

Individual provider Active NPI

Braxton Seiya Fukutomi

  • Internal Medicine Physician
  • Honolulu, HI
National Provider Identifier
1053970350
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MDR-7736 Issued in HI
Practice address
2828 Paa St
Honolulu, HI 96819-4430
Phone
(808) 432-5777
NPI assigned
Jun 10, 2019
Last updated
Mar 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MDR-7736 HI Primary

Addresses

Primary practice location

2828 Paa St
Honolulu, HI 96819-4430

Mailing address

2828 Paa St
Honolulu, HI 96819-4430

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bfukutomi714380@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI, UT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221109001531 HI Practitioner - Internal Medicine 3971970633 Reassigns benefits to 1 organization
I20240918000713 UT Practitioner - Internal Medicine 3971970633 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Hawaii John a. Burns School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-6387

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MDR-7736HIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Community Physicians Group Current Accepting new patients
University of Utah Adult Services CurrentSince Aug 10, 2024 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Community Physicians Group CurrentSince Jan 3, 2025 Accepting new patients
University of Utah Community Physicians Group CurrentSince Jan 3, 2025 Accepting new patients
University of Utah Adult Services CurrentSince Aug 10, 2024 Accepting new patients
Hawaii Permanente Medical Group Inc CurrentSince Sep 26, 2022 Accepting new patients
Bronson Lakeview Hospital Internal Medicine Past Accepting new patients

Locations

2828 Paa St
Honolulu, HI 96819
Phone (808) 432-5700

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 9

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1053970350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 PAA ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968194430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 PAA ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968194430",
            "telephone_number": "808-432-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUKUTOMI",
        "first_name": "BRAXTON",
        "middle_name": "SEIYA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-10",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MDR-7736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfukutomi714380@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.