Pediatric Professionals, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD4255 Issued in HI

Legal business name

PEDIATRIC PROFESSIONALS, INC.

Practice address

1350 S King St Ste 300
Honolulu, HI 96814-2066

Phone

(808) 593-9944

Fax

(808) 593-0565

NPI assigned

Mar 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wallace J Matthews Jr., M.D.

Title

President

Phone

(808) 593-9944

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194842674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 S KING ST STE 300",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968142066",
            "telephone_number": "808-593-9944",
            "fax_number": "808-593-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S KING ST STE 300",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968142066",
            "telephone_number": "808-593-9944",
            "fax_number": "808-593-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PROFESSIONALS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-593-9944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "HI",
            "license": "MD4255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHA",
            "identifier": "02534679801",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMAI",
            "identifier": "192509",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA 2",
            "identifier": "04481",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSS",
            "identifier": "00519101",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QHCP",
            "identifier": "MD4255-01",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "J4489",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00519101",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QHMS 2",
            "identifier": "0000004481",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert C. Pedersen, M.D.
• Pediatric Group of Honolulu, LLP
• Pediatric Medical Group, LLC
• Pediatric Ophthalmology Associates of Hawaii Inc
• Pediatric Orthotic and Prosthetic Services - Honolulu, LLC
• Pediatrics Associates, Inc.
• Pediatrics Associates, Inc.
• Pedodontic Associates Inc
• Cassidy Pedraza, MS, GC
• Jerelyn Tagap Pedrina-Schiessel, MSN, FNP-BC

• Specialist in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Specialist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.