NPIMap

Kau Hospital

Organization Active NPI Rural Health Clinic/Center · Hilo, HI

NPI 1164083374 · NPPES record last updated Aug 14, 2020

Key facts

NPI
1164083374
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
KAU HOSPITAL
Practice address
1285 Waianuenue Ave
Hilo, HI 96720-1209
Phone
(808) 932-3940
Fax
(808) 933-0011
NPI assigned
Jun 27, 2019
Organization subpart
No

Authorized official

Name
Lauri Elizabeth Redus
Title
Regional RHC Administrator
Phone
(808) 932-3801

Owners & managing parties with NPI records 2

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

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 7

Organizations that report the same tax identification number in the National Provider Directory.

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

Facilities with the same owner 34

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

View all 34

Practitioners 138

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 138

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D2170987East Hawaii Health Clinic at 1285 Waianuenue
1285 Waianuenue Ave, Hilo, HI 96720		Certificate of waiverMar 31, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in HI

Rural health clinic certification: CCN 123984

Legal name
KAU HOSPITAL
Doing business as
EAST HAWAII HEALTH CLINIC AT 1285 WAIANUENUE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 6, 2020
Last certification
May 6, 2020
Ownership / control type
2B
Organization structure
Other · Non-profit
Incorporated
Jul 1, 1996 in HI
Enrollment address
1285 Waianuenue Ave
Hilo, HI 96720-1209
Related CCNs
121301

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Daniel H Belcher
Individual 		Corporate Director 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
Board Member		 Apr 1, 2019
Yvonne Wong
Individual 		Corporate Director Oct 1, 2022
Daniel John Brinkman
Individual 		Corporate Officer
Ceo		 Jun 22, 2015
Jennifer J Walker
Individual 		Contracted Managing Employee
Medical Director		 Aug 29, 2019
Chad Keone Farias
Individual 		Corporate Director Mar 1, 2021
Joseph F Skruch
Individual 		Corporate Director Mar 15, 2022
Jennifer L Zelko-Schlueter
Individual 		Corporate Director Jul 1, 2022
Joni Mu Waltjen
Individual 		Corporate Officer
Cfo		 Apr 8, 2002
Kelsi Jerrell Staub
Individual 		W-2 Managing Employee May 16, 2018
Juliette M Tulang
Individual 		Corporate Director Jan 16, 2024
Hawaii Health Systems Corporation
Organization · Honolulu, HI
Corporation, Non-profit 		Operational/Managerial Control Jul 1, 1996 100%
Clarysse K Nunokawa
Individual 		Corporate Director
Board Member		 Jun 1, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20200217004865 HI Part a Provider - Rural Health Clinic 7416945548 Practice locations: Hilo, HI

National Provider Directory

Tax ID family
Kau Hospital (8 organizations share this tax ID)

Locations

75 Puuhonu Pl
Ste 100
Hilo, HI 96720
Phone (808) 932-3940

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

1285 Waianuenue Ave
Hilo, HI 96720-1209

Mailing address

PO Box 40
Pahala, HI 96777-0040
Phone (808) 932-3801

Other names

  • East Hawaii Health Clinic at 1285 Waianuenue Doing business as
  • East Hawaii Health Clinic at Puuhonu Way Doing business as

Other providers in Hilo, HI

All providers in Hilo, HI · Rural Health Clinic/Center in Hawaii

Sources for this page

Verify at the official NPI Registry.