NPIMap

Individual provider Active NPI

Michael Takeshi Tanoue, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1124360615
Registry record updated Mar 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A142396 Issued in CA
Practice address
650 Charles E Young Dr S
Los Angeles, CA 90095-4872
Phone
(310) 666-2912
Fax
(310) 206-9133
NPI assigned
Mar 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X A142396 CA Primary

Addresses

Primary practice location

650 Charles E Young Dr S
Los Angeles, CA 90095-4872

Mailing address

505 E 70TH St
New York, NY 10021-4872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190814001041 HI Practitioner - Cardiovascular Disease (Cardiology) 2163759143 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Creighton University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians
The Queens Medical CenterGroup PAC ID 3476454067, 191 clinicians

Practice addresses (Care Compare)

1301 Punchbowl St
Honolulu, HI 96813-2499

1380 Lusitana St
Honolulu, HI 96813-2448

550 S Beretania St
Honolulu, HI 96813-2496

67-1125 Mamalaho Hwy
Kamuela, HI 96743-8496
Phone (808) 881-4400

91 -2127 Fort Weaver Rd
Ewa Beach, HI 96706-1993

91 -2139 Fort Weaver Rd
Ewa Beach, HI 96706-3608

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.05 of 100Reported as apm
Quality
89.81
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
97.05 of 100Reported as apm
Quality
89.81
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A142396CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Queens Medical Center CurrentSince Aug 1, 2019 Accepting new patients
Queens University Medical Group CurrentSince Apr 22, 2022 Accepting new patients
The Queen'S Medical Center CurrentSince Aug 1, 2019 Accepting new patients
North Hawaii Community Hospital CurrentSince Mar 10, 2020 Accepting new patients
Queens North Hawaii Community Hospital CurrentSince Mar 10, 2020 Accepting new patients

Locations

550 S Beretania St
Ste 404
Honolulu, HI 96813
Phone (808) 691-8897

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

550 S Beretania St
Ste 601
Honolulu, HI 96813
Phone (808) 691-8877

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

67-1125 Mamalahoa Hwy
Kamuela, HI 96743
Phone (808) 881-4400

Networks

  • HI PPO
  • devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1124360615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 CHARLES E YOUNG DR S",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900954872",
            "telephone_number": "310-666-2912",
            "fax_number": "310-206-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANOUE",
        "first_name": "MICHAEL",
        "middle_name": "TAKESHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-22",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A142396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.