Individual provider Active NPI

Paul W. Grandon, MD

  • Internal Medicine Physician
  • Wailuku, HI
National Provider Identifier
1215908959
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD-21227 Issued in HI
Practice address
55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone
(808) 243-6050
NPI assigned
Jan 31, 2006
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD-21227 HI Primary
Internal Medicine Physician 207R00000X 017275 LA

Addresses

Primary practice location

55 Maui Lani Pkwy
Wailuku, HI 96793-2416

Mailing address

55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050

Other identifiers 2

IdentifierTypeStateIssuer
017275OtherLALICENSE
1364738MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, 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
I20100702000078 LA Practitioner - Internal Medicine 6002814597 Reassigns benefits to 1 organization
I20220330000593 HI Practitioner - Internal Medicine 6002814597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hawaii Permanente Medical Group IncGroup PAC ID 7618880667, 705 clinicians

Practice addresses (Care Compare)

55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-21227HIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Mar 14, 2022 Accepting new patients
Hospital Service District No 1-a of the Parish of Richland State of la CurrentSince Feb 1, 1984 Accepting new patients
Hospital Service District No 1-a of the Parish of Richland State of la Internal Medicine CurrentSince Feb 1, 1984 Accepting new patients

Locations

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

55 Maui Lani Pkwy
Wailuku, HI 96793
Phone (808) 243-6000

407 Cincinnati St
Delhi, LA 71232
Phone (318) 878-5171

501 Broadway St
Delhi, LA 71232
Phone (318) 878-6650

508 Broadway St
Delhi, LA 71232
Phone (318) 878-3737

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1215908959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-243-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-243-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDON",
        "first_name": "PAUL",
        "middle_name": "W.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MD-21227",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "017275",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "017275",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1364738",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "55 Maui Lani Pkwy",
            "city": "Wailuku",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967932416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.