Individual provider Active NPI

Kristy Melissa Shine, MD, PHD

  • Emergency Medicine Physician
  • Honolulu, HI
National Provider Identifier
1184043150
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD22418 Issued in HI
Practice address
770 Kapiolani Blvd Ste 705
Honolulu, HI 96813-5241
Phone
(808) 597-8799
NPI assigned
Apr 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD459017 PA
Emergency Medicine Physician 207P00000X MD22418 HI Primary

Addresses

Primary practice location

770 Kapiolani Blvd Ste 705
Honolulu, HI 96813-5241

Mailing address

770 Kapiolani Blvd Ste 705
Honolulu, HI 96813-5241
Phone (808) 597-8799

Other practice location 1

1020 Sansom St Ste 239
Philadelphia, PA 19107-5002
Phone (267) 324-7253

Other identifiers 1

IdentifierTypeStateIssuer
MD-22418OtherHIMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, HI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181220002509 PA Practitioner - Emergency Medicine 8921343807 Reassigns benefits to 1 organization
I20220609002534 HI Practitioner - Emergency Medicine 8921343807 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Pittsburgh School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emergency Group, Inc.Group PAC ID 1355244542, 49 clinicians

Practice addresses (Care Compare)

91 -2127 Fort Weaver Rd
Ewa Beach, HI 96706-1993
Phone (808) 597-8778

Hospital & facility affiliations

  • The Queens Medical Center Hospital, Honolulu, HI, CCN 120001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD22418HIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Acute Care Physicians, PC CurrentSince Nov 5, 2018 Accepting new patients
Jefferson Acute Care Physicians, PC CurrentSince Nov 5, 2018 Accepting new patients
The Emergency Group, Inc. Emergency Medicine CurrentSince May 1, 2022 Accepting new patients

Locations

91-2141 Fort Weaver Rd
Ewa Beach, HI 96706
Phone (808) 678-7000

770 Kapiolani Blvd
Ste 705
Honolulu, HI 96813
Phone (808) 597-8778

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

700 Walnut St
Philadelphia, PA 19106
Phone (215) 503-7300

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1184043150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 KAPIOLANI BLVD STE 705",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135241",
            "telephone_number": "808-597-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 KAPIOLANI BLVD STE 705",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135241",
            "telephone_number": "808-597-8799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 Sansom St Ste 239",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191075002",
            "country_code": "US",
            "telephone_number": "267-324-7253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHINE",
        "first_name": "KRISTY",
        "middle_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-07",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD459017",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "MD22418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD-22418",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.