NPIMap

Organization Active NPI

Hospice Maui, Inc

  • Community Based Hospice Care Agency
  • Wailuku, HI
National Provider Identifier
1063445690
Registry record updated Jan 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
W40836976-01 Issued in HI
Legal business name
HOSPICE MAUI, INC
Practice address
400 Mahalani St
Wailuku, HI 96793-2547
Phone
(808) 244-5555
Fax
(808) 244-5557
NPI assigned
Jul 8, 2006
Last updated
Jan 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2016

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

Authorized official

Name
Dr. Gregory Lagoy, N.D.
Title
Executive Dorector
Phone
(808) 244-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X W40836976-01 HI Primary

Addresses

Primary practice location

400 Mahalani St
Wailuku, HI 96793-2547

Mailing address

400 Mahalani St
Wailuku, HI 96793-2547
Phone (808) 244-5555

Other identifiers 2

IdentifierTypeStateIssuer
00089797OtherHIHMSA PROVIDER NUMBER
06921101MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080320000707 HI Part A Provider - Hospice 2264518992 Practice locations: Wailuku, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063445690. Details of each certification follow.

Hospice certification: CCN 121504

Legal name
HOSPICE MAUI, INC.
Doing business as
HOSPICE MAUI HALE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 10, 1991
Last certification
Mar 4, 2022
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Nov 16, 1981 in HI
Enrollment address
400 Mahalani St
Wailuku, HI 96793-2547

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice MauiCCN 121504 · All quality measures
Ownership
Non-Profit
Certified
May 10, 1991
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Hospice Maui Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

400 Mahalani St
Wailuku, HI 96793
Phone (800) 244-5555

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brian K. Yano Individual Corporate DirectorDirector Oct 31, 2012
Chad Farmer Individual W-2 Managing EmployeeMD; Jul 12, 2019
Barry a. Hyman Individual Corporate DirectorDirector Oct 27, 2010
Melanie Dwyer Individual Corporate DirectorCeo, Administrator Jan 4, 2022
James N. Whitcomb Individual Corporate DirectorDirector Oct 27, 2010
Scott Crockford Individual Corporate DirectorDirector/President Oct 28, 2009
Marilyn Griffin Individual Corporate DirectorSecretary Oct 24, 2019
Sherri L. Reeve Individual Corporate DirectorDirector Oct 30, 2013
Jennifer Bernard Individual W-2 Managing EmployeeClinical Director Jul 2, 2018
Matthew Pietsch Individual Corporate DirectorDirector/Secretary Oct 26, 2011
David J. Krueger Individual Corporate DirectorDirector Oct 31, 2012
Lisa Gilden Individual Corporate DirectorBoard Member Aug 11, 2021
Rowena Marciel-Enomoto Individual Corporate DirectorDirector Oct 27, 2010
Gregory M. Knue Individual Corporate DirectorDirector/Treasurer Oct 31, 2012
Wiebke Daniels Individual Operational/Managerial ControlSr Associate Accountig & Finance Dec 2, 2002
Dale Bonar Individual Corporate DirectorDirector Oct 30, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 12

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.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453939200000",
    "number": "1063445690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932547",
            "telephone_number": "808-244-5555",
            "fax_number": "808-244-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932547",
            "telephone_number": "808-244-5555",
            "fax_number": "808-244-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE MAUI, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2016-01-28",
        "status": "A",
        "authorized_official_last_name": "LAGOY",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "EXECUTIVE DORECTOR",
        "authorized_official_telephone_number": "808-244-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.D."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "HI",
            "license": "W40836976-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA PROVIDER NUMBER",
            "identifier": "00089797",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06921101",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.