NPIMap

Individual provider Active NPI

Stacy K Kanayama-Trivedi, M.D.

  • Family Medicine Physician
  • Jbphh, HI
National Provider Identifier
1164633954
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
202089 Issued in LA
Practice address
480 Central Ave
Department of Family Medicine
Jbphh, HI 96860-4908
Phone
(808) 473-1880
Fax
(808) 473-4411
NPI assigned
May 24, 2007
Last updated
May 20, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 202089 LA Primary

Addresses

Primary practice location

480 Central Ave
Department of Family Medicine
Jbphh, HI 96860-4908

Mailing address

480 Central Ave
Department of Family Medicine
Jbphh, HI 96860-4908
Phone (808) 473-1880

Other identifiers 1

IdentifierTypeStateIssuer
1092479MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140807001482 HI Practitioner - Family Practice 1355417312 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Straub Clinic and HospitalGroup PAC ID 6305759754, 420 clinicians
Hawaiian Island ClinicsGroup PAC ID 2769997188, 11 clinicians

Practice addresses (Care Compare)

1100 Ward Ave
Suite 840
Honolulu, HI 96814-1610
Phone (808) 522-4521

347 N Kuakini St
Honolulu, HI 96817-2306
Phone (808) 547-9105

888 S King St
Honolulu, HI 96813-3097
Phone (808) 522-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
202089LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kapiolani Medical Specialists CurrentSince Jun 21, 2015 Accepting new patients
Straub Clinic & Hospital CurrentSince Jul 14, 2014 Accepting new patients
Straub Clinic & Hospital CurrentSince Jul 14, 2014 Accepting new patients
Hawaiian Island Clinics CurrentSince Jul 1, 2025 Accepting new patients
Hawaii Injury Recovery Center, Inc CurrentSince Aug 16, 2025 Accepting new patients
William K. Morioka, M.D., Inc. PastSince Aug 16, 2025 Accepting new patients
Straub Clinic & Hospital Past Accepting new patients

Locations

1319 Punahou St
Honolulu, HI 96826
Phone (808) 485-4300

1946 Young St
Ste 320
Honolulu, HI 96826

321 N Kuakini St
Ste 501
Honolulu, HI 96817
Phone (808) 521-0330

347 N Kuakini St
Honolulu, HI 96817
Phone (808) 536-2236

888 S King St
Honolulu, HI 96813
Phone (808) 522-4000

Networks

  • HI PPO
  • devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ICCCCD/Endpoint/ICCCCD

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1164633954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "address_2": "DEPARTMENT OF FAMILY MEDICINE",
            "city": "JBPHH",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-473-1880",
            "fax_number": "808-473-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "address_2": "DEPARTMENT OF FAMILY MEDICINE",
            "city": "JBPHH",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-473-1880",
            "fax_number": "808-473-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANAYAMA-TRIVEDI",
        "first_name": "STACY",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "202089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1092479",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jbphh, HI

Sources for this page

Verify at the official NPI Registry.