NPIMap

Organization Active NPI

Kau Hospital

  • Rural Health Clinic/Center
  • Pahala, HI
National Provider Identifier
1144304338
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
123976 Issued in HI
Legal business name
KAU HOSPITAL
Practice address
1 Kamani Street
Pahala, HI 96777
Phone
(808) 928-2050
Fax
(808) 928-8980
NPI assigned
Oct 24, 2006
Last updated
Feb 7, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
HAWAII HEALTH SYSTEMS CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

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

Authorized official

Name
Mrs. Merilyn Harris
Title
Administrator
Phone
(808) 928-2050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 123976 HI Primary

Addresses

Primary practice location

1 Kamani Street
Pahala, HI 96777

Mailing address

PO Box 40
Pahala, HI 96777-0040
Phone (808) 928-2050

Other identifiers 1

IdentifierTypeStateIssuer
549769MedicaidHI

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505001311 HI Part A Provider - Rural Health Clinic 7416945548 Practice locations: Pahala, HI
O20040601000398 HI Part B Supplier - Clinic/Group Practice 7416945548 Receives reassigned benefits from 221 practitioners
1 other NPI on this enrollment
Practice locations: Hilo, HI; Pahoa, HI; Pahala, HI; Keaau, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144304338. Details of each certification follow.

Rural health clinic certification: CCN 123976

Legal name
KAU HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 13, 2003
Last certification
Jul 2, 2021
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Nov 3, 2007 in HI
Enrollment address
1 Kamani Street
Pahala, HI 96777-0040
Related CCNs
121301

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

  • Kau Hospital

    dba East Hawaii Health Primary Care

    • Rural Health Clinic/Center
    • Hilo, HI
    • NPI 1154111607

    7416945548

    Same PAC ID
  • Kau Hospital

    dba East Hawaii Health Clinic at 1285 Waianuenue

    • Rural Health Clinic/Center
    • Hilo, HI
    • NPI 1164083374

    7416945548

    Same PAC ID
  • Kau Hospital

    dba East Hawaii Health Clinic at Pahoa

    • Rural Health Clinic/Center
    • Pahoa, HI
    • NPI 1174777916

    7416945548

    Same PAC ID
  • Kau Hospital

    dba East Hawaii Health Clinic at Puna Kai

    • Rural Health Clinic/Center
    • Pahoa, HI
    • NPI 1285450163

    7416945548

    Same PAC ID
  • Kau Hospital

    dba East Hawaii Health Clinic at 1190 Waianuenue

    • Rural Health Clinic/Center
    • Hilo, HI
    • NPI 1336789874

    7416945548

    Same PAC ID
  • Kau Hospital
    • Critical Access Hospital
    • Pahala, HI
    • NPI 1558441311

    7416945548

    Same PAC ID
  • Kau Hospital

    dba East Hawaii Health Clinic at Kea'au

    • Rural Health Clinic/Center
    • Kea'au, HI
    • NPI 1649876913

    7416945548

    Same PAC ID
  • Kau Hospital
    • Medicare Defined Swing Bed Hospital Unit
    • Pahala, HI
    • NPI 1902977440

    7416945548

    Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Hawaii Health Systems Corporation

Locations

1285 Waianuenue Ave
Hilo, HI 96720
Phone (808) 932-3878

16-523 Keaau Pahoa Rd
Keaau, HI 96749
Phone (808) 932-3801

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Stephen M Smith Individual Corporate Director Jan 1, 2018
Daniel H Belcher Individual Corporate DirectorBoard Member Jun 1, 2020
Randall Kurohara Individual Corporate Director Feb 1, 2021
Lara Gomez Individual Corporate Director Nov 1, 2022
Jay M Ignacio Individual Corporate Director Apr 1, 2019
Yvonne Wong Individual Corporate Director Oct 1, 2022
Daniel John Brinkman Individual Corporate OfficerRegional Chief Executive Officer Aug 10, 2014 100%
Operational/Managerial ControlRegional Chief Executive Officer Aug 10, 2014 100%
Rae a Yamanaka Individual Corporate Director Jan 1, 2018
Chad Keone Farias Individual Corporate Director Mar 1, 2021
Joseph F Skruch Individual Corporate Director Mar 15, 2022
Deanna S Sako Individual Corporate Director Sep 1, 2018
Jennifer L Zelko-Schlueter Individual Corporate Director Jul 1, 2022
Joni Mu Waltjen Individual Corporate OfficerRegional Chief Financial Officer Apr 16, 2018 100%
Operational/Managerial ControlRegional Chief Financial Officer Apr 16, 2018 100%
Brenda S Ho Individual Corporate DirectorBoard Member Jul 1, 2016
Hawaii Health Systems Corporation Organization, Honolulu, HI Corporation Operational/Managerial Control Jul 1, 1996
Denise a Mackey Individual Corporate Officer Feb 2, 2004
Clarysse K Nunokawa Individual Corporate Director Jun 1, 2019
Lauri E Redus Individual W-2 Managing EmployeeRural Health Clinic Administrator Oct 30, 2016
Jerry L Gray Individual Corporate Director Jan 1, 2018

Owners & managing parties with NPI records 2

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

Facilities with the same owner 34

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 34

Practitioners & affiliated clinicians

Practitioners 230

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 230

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1144304338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "PAHALA",
            "state": "HI",
            "postal_code": "967770040",
            "telephone_number": "808-928-2050",
            "fax_number": "808-928-8980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KAMANI STREET",
            "city": "PAHALA",
            "state": "HI",
            "postal_code": "96777",
            "telephone_number": "808-928-2050",
            "fax_number": "808-928-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAU HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAWAII HEALTH SYSTEMS CORPORATION",
        "enumeration_date": "2006-10-24",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MERILYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "808-928-2050",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "HI",
            "license": "123976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "549769",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pahala, HI

Sources for this page

Verify at the official NPI Registry.