NPIMap

Organization Active NPI

Liberty Dialysis - Hawaii LLC

Doing business as Liberty Dialysis Hawaii-Hawaii Salt Lake

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Honolulu, HI
National Provider Identifier
1073060638
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
LIBERTY DIALYSIS - HAWAII LLC
Doing business as
Liberty Dialysis Hawaii-Hawaii Salt Lake
Practice address
4380 Lawehana St Ste 100
Honolulu, HI 96818-3129
Phone
(808) 423-6828
Fax
(808) 422-6049
NPI assigned
Sep 1, 2016
Last updated
Aug 26, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

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

Authorized official

Name
Denise Wright
Title
Vice President
Phone
(781) 676-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X HI Primary

Addresses

Primary practice location

4380 Lawehana St Ste 100
Honolulu, HI 96818-3129

Mailing address

4380 Lawehana St Ste 100
Honolulu, HI 96818-3129
Phone (808) 423-6828

Other identifiers 1

IdentifierTypeStateIssuer
12-2530OtherHIPTAN

Other names 1

  • LIBERTY DIALYSIS HAWAII-HAWAII SALT LAKE Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161125000114 HI Part A Provider - End-Stage Renal Disease Facility (ESRD) 1456372879 Practice locations: Honolulu, HI

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Liberty Dialysis Hawaii - Hawaii Salt LakeCCN 122530
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Aug 11, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Fresenius Medical Care
Dialysis stations
24

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

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
12D2170675Liberty Dialysis Hawaii LLC - Hawaii Salt Lake4380 Lawehana Street, Suite 100, Honolulu, HI 96818Certificate of waiverAug 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ability Network22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Affiliated clinicians 6

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": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1073060638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4380 LAWEHANA ST STE 100",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183129",
            "telephone_number": "808-423-6828",
            "fax_number": "808-422-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4380 LAWEHANA ST STE 100",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183129",
            "telephone_number": "808-423-6828",
            "fax_number": "808-422-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DIALYSIS - HAWAII LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2016-09-01",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-676-5200"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "HI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "12-2530",
            "state": "HI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "LIBERTY DIALYSIS HAWAII-HAWAII SALT LAKE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; 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.