Individual provider Active NPI

Joseph R Dicostanzo Jr., MD

  • Physical Medicine & Rehabilitation Physician
  • Honolulu, HI
National Provider Identifier
1114979507
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
13514 Issued in HI
Practice address
459 Patterson Rd
Honolulu, HI 96819-1522
Phone
(800) 214-3106
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 13514 HI Primary

Addresses

Primary practice location

459 Patterson Rd
Honolulu, HI 96819-1522

Mailing address

459 Patterson Rd
Honolulu, HI 96819-1522
Phone (800) 214-1306

Other identifiers 2

IdentifierTypeStateIssuer
0000267682OtherHMSA BILLING NUMBER
597148-02MedicaidHI

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13514HIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Nov 2, 2015 Accepting new patients
Jayhawk Healthcare LLC Occupational Medicine Past Accepting new patients

Locations

1010 Pensacola St
Fl 2
Honolulu, HI 96814

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

1010 Pensacola St
Honolulu, HI 96814
Phone (808) 432-2000

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1114979507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 PATTERSON RD",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968191522",
            "telephone_number": "800-214-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 PATTERSON RD",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968191522",
            "telephone_number": "800-214-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICOSTANZO",
        "first_name": "JOSEPH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "HI",
            "license": "13514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA BILLING NUMBER",
            "identifier": "0000267682",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597148-02",
            "state": "HI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1010 Pensacola St",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "968142118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.