Individual provider Active NPI

Laurie Keiko Omuro-Yamamoto, PH.D.

  • Psychologist
  • Wailuku, HI
National Provider Identifier
1114071875
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY-797 Issued in HI
Practice address
1787 Wili PA Loop Ste 7
Wailuku, HI 96793-1271
Phone
(808) 249-2121
Fax
(808) 242-8920
NPI assigned
Jan 22, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY-797 HI Primary

Addresses

Primary practice location

1787 Wili PA Loop Ste 7
Wailuku, HI 96793-1271

Mailing address

1787 Wili PA Loop Ste 7
Wailuku, HI 96793-1271
Phone (808) 249-2121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210302000162 HI Practitioner - Clinical Psychologist 7113222142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aloha House, Inc.Group PAC ID 8426948316, 15 clinicians

Practice addresses (Care Compare)

135 S Wakea Ave
Suite 201
Kahului, HI 96732-1385
Phone (808) 249-2121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY-797HIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aloha House, Inc. CurrentSince Feb 1, 2021 Accepting new patients

Locations

135 S Wakea Ave
Ste 201
Kahului, HI 96732
Phone (808) 249-2121

1787 Wili Pa Loop
Ste 7
Wailuku, HI 96793
Phone (808) 249-2121

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114071875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1787 WILI PA LOOP STE 7",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931271",
            "telephone_number": "808-249-2121",
            "fax_number": "808-242-8920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 WILI PA LOOP STE 7",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931271",
            "telephone_number": "808-249-2121",
            "fax_number": "808-242-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMURO-YAMAMOTO",
        "first_name": "LAURIE",
        "middle_name": "KEIKO",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "HI",
            "license": "PSY-797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.