NPIMap

Organization Active NPI

Scott J. Miscovich MD, LLC

  • Family Medicine Physician
  • Kaneohe, HI
National Provider Identifier
1073796868
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD6854 Issued in HI
Legal business name
SCOTT J. MISCOVICH MD, LLC
Practice address
46-001 Kamehameha Hwy Ste 109
Kaneohe, HI 96744-3724
Phone
(808) 247-7596
NPI assigned
Dec 14, 2007
Last updated
Sep 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Rene Noelle Mansanas
Title
Executive Vice President
Phone
(808) 379-1515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD6854 HI Primary

Addresses

Primary practice location

46-001 Kamehameha Hwy Ste 109
Kaneohe, HI 96744-3724

Mailing address

46-001 Kamehameha Hwy Ste 109
Kaneohe, HI 96744-3724
Phone (808) 247-7596

Other identifiers 2

IdentifierTypeStateIssuer
T065197OtherHIHMSA
05672605MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311001394 HI Part B Supplier - Clinic/Group Practice 2961391537 Receives reassigned benefits from 9 practitioners
Practice locations: Kaneohe, 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
12D1014638Scott J Miscovich, MD46-001 Kamehameha Hwy Suite 109, Kaneohe, HI 96744Provider-performed microscopyJul 10, 2027

National Provider Directory

National Provider Directory

Locations

45-1144 Kamehameha Hwy
Ste 500
Kaneohe, HI 96744
Phone (808) 247-7596

46-001 Kamehameha Hwy
Ste 109
Kaneohe, HI 96744
Phone (808) 247-7596

Interoperability endpoints

  • Direct secure messaging: elizabeth.stoltzman@hawaiihie.medicity.net
  • Direct secure messaging: kaipo.lindsey@hawaiihie.medicity.net
  • Direct secure messaging: scott.miscovich@hawaiihie.medicity.net
  • Direct secure messaging: shelean.roylance@hawaiihie.medicity.net

Practitioners & affiliated clinicians

Practitioners 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1073796868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46-001 KAMEHAMEHA HWY STE 109",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967443724",
            "telephone_number": "808-247-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46-001 KAMEHAMEHA HWY STE 109",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967443724",
            "telephone_number": "808-247-7596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT J. MISCOVICH MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "MANSANAS",
        "authorized_official_first_name": "RENE",
        "authorized_official_middle_name": "NOELLE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "808-379-1515"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD6854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "T065197",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05672605",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kaneohe, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; 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.