Individual provider Active NPI

Adam Roller, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Ewa Beach, HI
National Provider Identifier
1194143537
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN-1711 Issued in HI
Practice address
91-1001 Kaimalie St Ste 201B
Ewa Beach, HI 96706-6250
Phone
(808) 762-0026
Fax
(808) 427-9397
NPI assigned
Apr 2, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN-1711 HI Primary
Adult Health Nurse Practitioner 363LA2200X APRN-1711 HI

Addresses

Primary practice location

91-1001 Kaimalie St Ste 201B
Ewa Beach, HI 96706-6250

Mailing address

1245 Kuala St
Pearl City, HI 96782-3900
Phone (808) 456-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140910000934 HI Practitioner - Nurse Practitioner 1951520709 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Brody School of Medicine at East Carolina University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
West Oahu Mental HealthGroup PAC ID 1951772227, 2 clinicians

Practice addresses (Care Compare)

91 -1001 Kaimalie St
Suite 201B
Ewa Beach, HI 96706-6250
Phone (808) 762-0026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN-1711HIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Psychiatric Therapeutics CurrentSince Apr 1, 2017 Accepting new patients
West Oahu Mental Health Psychiatric/Mental Health CurrentSince Jan 4, 2023 Accepting new patients

Locations

91-1001 Kaimalie St
Ste 201B
Ewa Beach, HI 96706
Phone (808) 230-5224

1164 Bishop St
Ste 1611
Honolulu, HI 96813
Phone (808) 261-7792

40 Aulike St
Ste 312
Kailua, HI 96734
Phone (808) 261-7792

Interoperability endpoints

  • Direct secure messaging: westoahumentalhealth.adamroller@153660.advancedmd-direct.com

Organizations & group practices 2

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1194143537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 KUALA ST",
            "city": "PEARL CITY",
            "state": "HI",
            "postal_code": "967823900",
            "telephone_number": "808-456-2273",
            "fax_number": "808-456-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-1001 KAIMALIE ST STE 201B",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967066250",
            "telephone_number": "808-762-0026",
            "fax_number": "808-427-9397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLER",
        "first_name": "ADAM",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "HI",
            "license": "APRN-1711",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "HI",
            "license": "APRN-1711",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ewa Beach, HI

Sources for this page

Verify at the official NPI Registry.