NPIMap

Organization Active NPI

Kau Hospital

Doing business as East Hawaii Health Clinic at 1285 Waianuenue

  • Rural Health Clinic/Center
  • Hilo, HI
National Provider Identifier
1164083374
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KAU HOSPITAL
Doing business as
East Hawaii Health Clinic at 1285 Waianuenue
East Hawaii Health Clinic at Puuhonu Way
Practice address
1285 Waianuenue Ave
Hilo, HI 96720-1209
Phone
(808) 932-3940
Fax
(808) 933-0011
NPI assigned
Jun 27, 2019
Last updated
Aug 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Authorized official

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

Specialties & licenses 1

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

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 2

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164083374. Details of each certification follow.

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
OtherNon-profit
Incorporated
Jul 1, 1996 in HI
Enrollment address
1285 Waianuenue Ave
Hilo, HI 96720-1209
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
    • Rural Health Clinic/Center
    • Pahala, HI
    • NPI 1144304338

    7416945548

    Same PAC ID
  • 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 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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D2170987East Hawaii Health Clinic at 1285 Waianuenue1285 Waianuenue Ave, Hilo, HI 96720Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kau Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

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 DirectorBoard Member Apr 1, 2019
Yvonne Wong Individual Corporate Director Oct 1, 2022
Daniel John Brinkman Individual Corporate OfficerCeo Jun 22, 2015
Jennifer J Walker Individual Contracted Managing EmployeeMedical 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 OfficerCfo 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 DirectorBoard Member Jun 1, 2019

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

NPI Registry JSON

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1164083374",
    "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": "808-932-3801",
            "fax_number": "808-935-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1285 WAIANUENUE AVE",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967201209",
            "telephone_number": "808-932-3940",
            "fax_number": "808-933-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAU HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-27",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "REDUS",
        "authorized_official_first_name": "LAURI",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "REGIONAL RHC ADMINISTRATOR",
        "authorized_official_telephone_number": "808-932-3801"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Hawaii Health Clinic at 1285 Waianuenue",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Hawaii Health Clinic at Puuhonu Way",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Hawaii Health Clinic at Puuhonu Way",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hilo, HI

Sources for this page

Verify at the official NPI Registry.