NPIMap

Organization Active NPI

Mahinakealo, LLC

Doing business as Mahinakealo Dermatology

  • Dermatology Physician
  • Hilo, HI
National Provider Identifier
1144844473
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MAHINAKEALO, LLC
Doing business as
Mahinakealo Dermatology
Practice address
670 Ponahawai St Ste 224
Hilo, HI 96720-7829
Phone
(808) 300-1064
Fax
(808) 400-5886
NPI assigned
Jun 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Dr. Jonathan Walsh, PHD
Title
Practice Manager
Phone
(808) 300-1064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

670 Ponahawai St Ste 224
Hilo, HI 96720-7829

Mailing address

670 Ponahawai St Ste 224
Hilo, HI 96720-7829
Phone (808) 300-1064

Other names 1

  • Mahinakealo Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221222001975 HI Part B Supplier - Clinic/Group Practice 0547676843 Receives reassigned benefits from 3 practitioners
Practice locations: Hilo, HI

National Provider Directory

National Provider Directory

Locations

670 Ponahawai St
Ste 224
Hilo, HI 96720
Phone (808) 300-1064

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1144844473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 PONAHAWAI ST STE 224",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967207829",
            "telephone_number": "808-300-1064",
            "fax_number": "808-400-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 PONAHAWAI ST STE 224",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967207829",
            "telephone_number": "808-300-1064",
            "fax_number": "808-400-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHINAKEALO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-02",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "808-300-1064",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mahinakealo Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hilo, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.