NPIMap

Organization Active NPI

Kau Hospital

Doing business as East Hawaii Health Clinic at Pahoa

  • Rural Health Clinic/Center
  • Pahoa, HI
National Provider Identifier
1174777916
Registry record updated Oct 10, 2024
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 Pahoa
Practice address
15-2662 Pahoa Village Rd
Suite 301, 303-305, 307
Pahoa, HI 96778-7730
Phone
(808) 965-1801
NPI assigned
Nov 6, 2008
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Lauri Elizabeth Redus
Title
Rural Health Clinic Practice Admin
Phone
(808) 932-3801

Specialties & licenses 1

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

Addresses

Primary practice location

15-2662 Pahoa Village Rd
Suite 301, 303-305, 307
Pahoa, HI 96778-7730

Mailing address

15-2660 Pahoa Village Road
Suite 306, PMB 8741
Pahoa, HI 96778-7802
Phone (808) 965-1801

Other identifiers 1

IdentifierTypeStateIssuer
832396MedicaidHI

Other names 1

  • East Hawaii Health Clinic at Pahoa Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091116000523 HI Part B Supplier - Clinic/Group Practice 1254479033 Receives reassigned benefits from 4 practitioners
Practice locations: Pahoa, HI
O20181112000804 HI Part A Provider - Rural Health Clinic 7416945548 Practice locations: Pahoa, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174777916. Details of each certification follow.

Rural health clinic certification: CCN 123979

Legal name
KAU HOSPITAL
Doing business as
EAST HAWAII HEALTH CLINIC AT PAHOA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 28, 2018
Last certification
Oct 13, 2021
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1996 in HI
Enrollment address
15-2662 Pahoa Village Rd
Ste 301, 303-305, 307
Pahoa, HI 96778-7730
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 1285 Waianuenue

    • Rural Health Clinic/Center
    • Hilo, HI
    • NPI 1164083374

    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
12D1096251East Hawaii Health Clinic at Pahoa15-2662 Pahoa Village Rd Suite 303 PMB 8741, Pahoa, HI 96778Certificate of waiverAug 13, 2027

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.

Locations

15-2660 Pahoa Village Rd
Ste 306
Pahoa, HI 96778

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Stephen M Smith Individual Corporate DirectorEast Hawaii Regional Board Membe Feb 24, 2018
Daniel H Belcher Individual Corporate DirectorChair, East Hawaii Regional Boar 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 Apr 1, 2019
Yvonne Wong Individual Corporate Director Oct 1, 2022
Daniel John Brinkman Individual Corporate OfficerCeo Jun 22, 2015
Rae a Yamanaka Individual Corporate DirectorSecretary/Treasurer, East Hawaii May 17, 2016
Chad Keone Farias Individual Corporate Director Jun 1, 2020
Joseph F Skruch Individual Corporate Director Mar 15, 2022
Deanna S Sako Individual Corporate Director Sep 1, 2018
Jennifer L Zelko-Schlueter Individual Corporate Director Jul 1, 2022
Joni Mu Waltjen Individual Corporate OfficerChief Financial Officer Apr 8, 2002
Brenda S Ho Individual Corporate DirectorEast Hawaii Regional Board Membe Jul 1, 2016
Hawaii Health Systems Corporation Organization, Honolulu, HI Corporation Operational/Managerial Control Jul 1, 1996 100%
Denise a Mackey Individual Corporate Officer Feb 2, 2024
Clarysse K Nunokawa Individual Corporate Director Jun 1, 2020
Lauri E Redus Individual Operational/Managerial ControlPractice Administration Feb 1, 2018
Jerry L Gray Individual Corporate DirectorEast Hawaii Regional Board Membe Feb 1, 2017

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1225929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1174777916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15-2660 PAHOA VILLAGE ROAD",
            "address_2": "SUITE 306, PMB 8741",
            "city": "PAHOA",
            "state": "HI",
            "postal_code": "967787802",
            "telephone_number": "808-965-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15-2662 PAHOA VILLAGE RD",
            "address_2": "SUITE 301, 303-305, 307",
            "city": "PAHOA",
            "state": "HI",
            "postal_code": "967787730",
            "telephone_number": "808-965-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAU HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-06",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "REDUS",
        "authorized_official_first_name": "LAURI",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "RURAL HEALTH CLINIC PRACTICE ADMIN",
        "authorized_official_telephone_number": "808-932-3801"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "832396",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Hawaii Health Clinic at Pahoa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pahoa, HI

Sources for this page

Verify at the official NPI Registry.