NPIMap

Organization Active NPI

West Hawaii Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Keaau, HI
National Provider Identifier
1104874619
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WEST HAWAII COMMUNITY HEALTH CENTER, INC.
Practice address
16-192 Pili Mua St
Keaau, HI 96749-8134
Phone
(808) 930-0400
Fax
(808) 961-5678
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Richard J Taaffe
Title
Ceo
Phone
(808) 326-3884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X HI Primary

Addresses

Primary practice location

16-192 Pili Mua St
Keaau, HI 96749-8134

Mailing address

75-5751 Kuakini Hwy Ste 203
Kailua Kona, HI 96740-1753
Phone (808) 326-5629

Other identifiers 1

IdentifierTypeStateIssuer
592528MedicaidHI

Other names 2

  • Hawaii Island Community Health Center Doing business as
  • Kea'au Family Health and Dental Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031120000512 HI Part B Supplier - Clinic/Group Practice 5890699037 Receives reassigned benefits from 22 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pahoa, HI; Naalehu, HI; Keaau, HI; Hilo, HI
O20231006002198 HI Part A Provider - Federally Qualified Health Center (FQHC) 1557389400 1 other NPI on this enrollment
Practice locations: Keaau, HI

Federally qualified health center certification: CCN 121829

Legal name
WEST HAWAII COMMUNITY HEALTH CENTER INC
Doing business as
HAWAII ISLAND COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 14, 2006
Last certification
Sep 14, 2006
Ownership / control type
For profit – corporation
Most recent change of ownership
Jul 1, 2022 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2003 in HI
Enrollment address
16-192 Pili Mua St
Keaau, HI 96749-8134

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
West Hawaii Community Health Center Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Richard J Taaffe Individual Corporate OfficerChief Executive Officer Oct 31, 2005
W-2 Managing EmployeeChief Executive Officer Oct 31, 2005
Joann Freed Individual Corporate Director Jan 1, 2022
Adam Keith Bauer Individual Corporate Director Jul 1, 2022
Michael Matsukawa Individual Corporate Director Jan 1, 2022
Haidee O Abe Individual Corporate Director Jul 1, 2022
Victoria K Hanes Individual Corporate OfficerCoo Aug 30, 2010
Diane Pautz Individual W-2 Managing EmployeeCfo Jul 28, 2008

Owners & managing parties with NPI records 1

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

Change-of-ownership history 2

DateEventCounterparty
Jul 1, 2022 Change of OwnershipThis provider was the buyer Keaau Family Health and Dental CenterCCN 121829, HI, NPI 1104874619
Jul 1, 2022 Change of OwnershipThis provider was the seller Hawaii Island Community Health CenterCCN 121829, HI, NPI 1104874619

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1104874619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5751 KUAKINI HWY STE 203",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401753",
            "telephone_number": "808-326-5629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16-192 PILI MUA ST",
            "city": "KEAAU",
            "state": "HI",
            "postal_code": "967498134",
            "telephone_number": "808-930-0400",
            "fax_number": "808-961-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST HAWAII COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "TAAFFE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "808-326-3884"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "HI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "592528",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hawaii Island Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kea'au Family Health and Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Keaau, HI

Sources for this page

Verify at the official NPI Registry.