NPIMap

Organization Active NPI

The Makana North Shore Clinic

Doing business as Makana North Shore Urgent Care

  • Urgent Care Clinic/Center
  • Princeville, HI
National Provider Identifier
1114431632
Registry record updated Aug 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
THE MAKANA NORTH SHORE CLINIC
Doing business as
Makana North Shore Urgent Care
Practice address
4488 Hanalei Plantation Rd
Princeville, HI 96722
Phone
(808) 320-7300
Fax
(808) 320-7303
NPI assigned
Nov 20, 2017
Last updated
Aug 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2024

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

Authorized official

Name
Dr. Edward Kimball, MDNPI 1699865204
Title
Owner
Phone
(808) 320-7300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

4488 Hanalei Plantation Rd
Princeville, HI 96722

Mailing address

1747 E Laird Ave
Salt Lake City, UT 84108-1806

Other names 1

  • Makana North Shore Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180905001897 HI Part B Supplier - Clinic/Group Practice 8426308883 Receives reassigned benefits from 62 practitioners
Practice locations: Princeville, 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
12D2209641Makana North Shore Clinic4488 Hanalei Plantation Road, Princeville, HI 96722Certificate of waiverJan 13, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

4488 Hanalei Plantation Rd
Princeville, HI 96722
Phone (808) 320-7300

Practitioners & affiliated clinicians

Practitioners 64

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 64

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725062400000",
    "number": "1114431632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 E LAIRD AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4488 HANALEI PLANTATION RD",
            "city": "PRINCEVILLE",
            "state": "HI",
            "postal_code": "96722",
            "telephone_number": "808-320-7300",
            "fax_number": "808-320-7303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MAKANA NORTH SHORE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2024-08-31",
        "certification_date": "2024-08-31",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-320-7300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Makana North Shore Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeville, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.