NPIMap

Organization Active NPI

Honolulu Spine Center, LLC

Doing business as Honolulu Sports & Spine Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Honolulu, HI
National Provider Identifier
1093830325
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
HONOLULU SPINE CENTER, LLC
Doing business as
Honolulu Sports & Spine Surgery Center
Practice address
500 Ala Moana Blvd Ste 301
Honolulu, HI 96813-4920
Phone
(808) 237-2970
NPI assigned
Mar 19, 2007
Last updated
Mar 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

500 Ala Moana Blvd Ste 301
Honolulu, HI 96813-4920

Mailing address

500 Ala Moana Blvd Ste 301
Honolulu, HI 96813-4920
Phone (808) 237-2970

Other names 1

  • Honolulu Sports & Spine Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070730000867 HI Part B Supplier - Ambulatory Surgical Center 8628179942 Receives reassigned benefits from 6 practitioners
Practice locations: Honolulu, HI

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Honolulu Spine CenterCCN 12C0001015
Medicare certification status
ActiveFrom the Provider of Services file

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
12D1072255Honolulu Spine Center LLC500 Ala Moana Blvd BLDG 1 Ste 301, Honolulu, HI 96813Certificate of waiverAug 9, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1093830325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ALA MOANA BLVD STE 301",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968134920",
            "telephone_number": "808-237-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ALA MOANA BLVD STE 301",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968134920",
            "telephone_number": "808-237-2970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HONOLULU SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5900"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Honolulu Sports & Spine Surgery Center",
            "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 Mar 10, 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.