Samuel Mahelona Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Lihue, HI
NPI 1083200232 · NPPES record last updated May 1, 2024
Key facts
- NPI
- 1083200232
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SAMUEL MAHELONA MEMORIAL HOSPITAL
- Practice address
- 4463 Pahee St Ste 206
Lihue, HI 96766-2000 - Phone
- (808) 241-5799
- Fax
- (808) 241-3188
- NPI assigned
- Dec 11, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- SAMUEL MAHELONA MEMORIAL HOSPITAL
Authorized official
- Name
- Christine Marie Asato
- Title
- Regional Cfo
- Phone
- (808) 338-9407
Owners & managing parties with NPI records 11
Owned or controlled facilities with NPI records 9
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 8
Related certifications (CCN) 1
Facilities with the same owner 36
Practitioners 52
-
Douglas E Ching, M.D.
-
Stephen D Coleman, M.D.
-
John T. Funai, M.D.
-
Jill Patience Lahmann, MS, MSW, LCSW
-
Amy Tanner Rodriguez, M.D.
-
Jennifer Marie Andrade, APRN
-
Elisabeth N. Biuk-Aghai, M.D.
-
Arthur H Brownstein, M.D.
-
Surachat Chatkupt, M.D.
-
Reese Dare, M.D.
-
Chelsea Ihope Domingcil, APRN
-
Ronald Y Fujimoto, D.O.
-
C. Mitchell Jenkins, M.D.
-
Kanwardeep S Kaleka, M.D., PHD
-
Susan Marie Minnich, FNP-BC
-
Juliana L Olds, LCSW
-
Mary Linda Paul, M.D.
-
Holly Marie Poag, D.O.
-
Scott K Ross, MD
-
Kanayo Sakai, NP
-
Kaoru Sakiyama, NP
-
Shelini Sooklal, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in HI
Rural health clinic certification: CCN 123985
- Legal name
- SAMUEL MAHELONA MEMORIAL HOSPITAL
- Doing business as
- HHSC - KAUAI REGION CLINICS THE CLINIC AT LIHUE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 8, 2021
- Last certification
- Oct 8, 2021
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Enrollment address
- 4463 Pahee St
Ste 206
Lihue, HI 96766-2000 - Related CCNs
- 121306
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Samuel Mahelona Memorial Hospital |
5% Or Greater Direct Ownership Interest | Dec 23, 2020 | 95% |
| Lance K Segawa |
Corporate Officer |
Apr 1, 2018 | 100% |
| W-2 Managing Employee |
Apr 1, 2018 | 100% | |
| Operational/Managerial Control |
Apr 1, 2018 | 100% | |
| Rhonelle Aceret |
W-2 Managing Employee |
Dec 17, 2018 | |
| Laurel K S Loo |
Corporate Director |
May 17, 2017 | |
| Tito Villanueva |
Corporate Director |
May 17, 2017 | |
| Donna Okada-Asher |
Corporate Director |
May 17, 2017 | |
| Patrick S Gegen |
Corporate Director |
May 17, 2017 | |
| Hawaii Health Systems Corporation |
5% Or Greater Direct Ownership Interest | Dec 23, 2020 | 5% |
| Stephanie N Iona |
Corporate Director |
May 15, 2017 | |
| Christine M Asato |
Corporate Officer |
Apr 1, 2018 | 50% |
| W-2 Managing Employee |
Apr 1, 2018 | 50% | |
| Operational/Managerial Control |
Apr 1, 2018 | 50% |
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Samuel Mahelona Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (95%) | Jul 1, 1996 |
| Samuel Mahelona Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (25%) Operational/Managerial Control (25%) |
Jan 29, 2010 Jan 29, 2010 |
| Samuel Mahelona Memorial Hospital |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Mar 17, 2017 Apr 1, 2015 |
| HHSC - Kauai Region Clinics the Clinic at Port Allen |
Rural health clinic | 5% Or Greater Direct Ownership Interest (95%) | Dec 23, 2020 |
| HHSC - Kauai Region Clinics the Clinic at Kapaa |
Rural health clinic | 5% Or Greater Direct Ownership Interest (95%) | Dec 23, 2020 |
| HHSC - Kauai Region Clinics the Specialty Clinic at Kalaheo |
Rural health clinic | 5% Or Greater Direct Ownership Interest (95%) | Dec 23, 2020 |
| HHSC - Kauai Region Clinics the Clinic at Kalaheo |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Dec 23, 2020 |
| HHSC - Kauai Region Clinics Urgent Care at Poipu |
Rural health clinic | 5% Or Greater Direct Ownership Interest (95%) | Dec 23, 2020 |
| HHSC - Kauai Region Clinics the Clinic at Waimea |
Rural health clinic | 5% Or Greater Direct Ownership Interest (95%) | Dec 23, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040318000116 | HI | Part B Supplier - Clinic/Group Practice | 1759271216 |
Receives reassigned benefits from 69 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lihue, HI; Waimea, HI; Koloa, HI; Kapaa, HI; Kalaheo, HI; Eleele, HI |
| O20210204002849 | HI | Part a Provider - Rural Health Clinic | 1759271216 | Practice locations: Lihue, HI |
National Provider Directory
- Tax ID family
- Samuel Mahelona Hospita
- Part of
- Samuel Mahelona Hospita
Locations
4463 Pahee St
Ste 206
Lihue, HI 96766
Phone (808) 241-5799
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
4463 Pahee St Ste 206
Lihue, HI 96766-2000
Mailing address
PO Box 337
Waimea, HI 96796-0337
Phone (808) 240-2723
Other names
- HHSC - Kauai Region Clinics The Clinic at Lihue
Other providers in Lihue, HI
- Tiffany Sagucio
- Kanayo Sakai
- Kaoru Sakiyama
- Sandra Lee Salmers
- JB Michael Sampsell
- Samuel Mahelona Memorial Hospital
- Jack Michael Sanchez
- Thomas C. Sanchez
- Sandra L Salmers
- Gavin Alain Sanjume
All providers in Lihue, HI · Rural Health Clinic/Center in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.