NPIMap

Organization Active NPI

Pukalani Family Practice, LLC

  • Primary Care Clinic/Center
  • Makawao, HI
National Provider Identifier
1063009207
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PUKALANI FAMILY PRACTICE, LLC
Practice address
81 Makawao Ave Ste 100
Makawao, HI 96768-8859
Phone
(808) 573-8900
Fax
(808) 573-7505
NPI assigned
Dec 22, 2020
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Mrs. Dayaji Green
Title
Office Manager
Phone
(808) 573-8900

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Primary Care Clinic/Center 261QP2300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X

Addresses

Primary practice location

81 Makawao Ave Ste 100
Makawao, HI 96768-8859

Mailing address

81 Makawao Ave Ste 100
Makawao, HI 96768-8859
Phone (808) 573-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210211003491 HI Part B Supplier - Clinic/Group Practice 2567877178 Receives reassigned benefits from 7 practitioners
Practice locations: Makawao, HI

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
12D0724063Pukalani Family Practice, LLC81 Makawao Ave, Ste 100, Makawao, HI 96768Certificate of waiverDec 26, 2027

National Provider Directory

National Provider Directory

Locations

81 Makawao Ave
Ste 100
Makawao, HI 96768
Phone (808) 573-8900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JCBAAA

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1063009207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 MAKAWAO AVE STE 100",
            "city": "MAKAWAO",
            "state": "HI",
            "postal_code": "967688859",
            "telephone_number": "808-573-8900",
            "fax_number": "808-573-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 MAKAWAO AVE STE 100",
            "city": "MAKAWAO",
            "state": "HI",
            "postal_code": "967688859",
            "telephone_number": "808-573-8900",
            "fax_number": "808-573-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUKALANI FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DAYAJI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "808-573-8900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Makawao, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.