Individual provider Active NPI

Gordon T. Dong, P.T.

  • Physical Therapist
  • Kailua Kona, HI
National Provider Identifier
1164572236
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-1377 Issued in HI
Practice address
73-5590 Kauhola St Ste a
Kailua Kona, HI 96740
Phone
(808) 329-7744
Fax
(808) 334-1608
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-1377 HI Primary

Addresses

Primary practice location

73-5590 Kauhola St Ste a
Kailua Kona, HI 96740

Mailing address

73-5590 Kauhola St Ste a
Kailua Kona, HI 96740-2610
Phone (808) 329-7744

Other practice location 1

75-5699 Kopiko St
Kailua Kona, HI 96740-1668
Phone (808) 329-7744

Other practice location 2

79-7422 Mamalahoa Hwy
Kealakekua, HI 96750
Phone (808) 322-8400

Other identifiers 7

IdentifierTypeStateIssuer
244903-02MedicaidHI
244903-01MedicaidHI
00A053908OtherHIHMSA QUEST
217706OtherHIHMA SUMMERLIN LIFE
A002OtherHITRICARE
00A0053908OtherHIHMSA BC BS
00A0053908OtherHIHMSA 65C PLUS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120223000940 HI Practitioner - Physical Therapist in Private Practice 0547173775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Club Rehab, Inc.Group PAC ID 0749193977, 11 clinicians

Practice addresses (Care Compare)

75 -5699 Kopiko St
Kailua Kona, HI 96740-3651
Phone (808) 329-7744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Club Rehab, Inc. Physical Therapist CurrentSince Jan 1, 2001 Accepting new patients

Locations

75-5699 Kopiko St
Kailua Kona, HI 96740
Phone (808) 329-7744

73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740
Phone (808) 329-7744

73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740

79-7422 Mamalahoa Hwy
Kealakekua, HI 96750
Phone (808) 322-8400

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1164572236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73-5590 KAUHOLA ST STE A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402610",
            "telephone_number": "808-329-7744",
            "fax_number": "808-334-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73-5590 KAUHOLA ST STE A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "96740",
            "telephone_number": "808-329-7744",
            "fax_number": "808-334-1608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75-5699 Kopiko St",
            "address_purpose": "LOCATION",
            "city": "Kailua Kona",
            "state": "HI",
            "postal_code": "967401668",
            "country_code": "US",
            "telephone_number": "808-329-7744",
            "fax_number": "808-334-1608",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79-7422 Mamalahoa Hwy",
            "address_purpose": "LOCATION",
            "city": "Kealakekua",
            "state": "HI",
            "postal_code": "96750",
            "country_code": "US",
            "telephone_number": "808-322-8400",
            "fax_number": "808-334-1608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONG",
        "first_name": "GORDON",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "PT-1377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244903-02",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244903-01",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA QUEST",
            "identifier": "00A053908",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMA SUMMERLIN LIFE",
            "identifier": "217706",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A002",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA BC BS",
            "identifier": "00A0053908",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA 65C PLUS",
            "identifier": "00A0053908",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.