Individual provider Active NPI

Jeffrey R. Tolan, MD

  • Family Medicine Physician
  • Kamuela, HI
National Provider Identifier
1245339639
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD-13422 Issued in HI
Practice address
67-1185 Mamalahoa Hwy
Kamuela, HI 96743-7304
Phone
(808) 881-4500
NPI assigned
Sep 21, 2006
Last updated
Oct 19, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD-13422 HI Primary

Addresses

Primary practice location

67-1185 Mamalahoa Hwy
Kamuela, HI 96743-7304

Mailing address

67-1185 Mamalahoa Hwy
Kamuela, HI 96743-7304
Phone (808) 881-4500

Other identifiers 2

IdentifierTypeStateIssuer
572835-03MedicaidHI
0000254938OtherHIHMSA BILLING NUMBER

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050928000401 HI Practitioner - Family Practice 4587636741 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Aug 29, 2005 Accepting new patients

Locations

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 432-8000

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

67-1185 Mamalahoa Hwy
Kamuela, HI 96743
Phone (808) 881-4500

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192752000000",
    "number": "1245339639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67-1185 MAMALAHOA HWY",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967437304",
            "telephone_number": "808-881-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67-1185 MAMALAHOA HWY",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967437304",
            "telephone_number": "808-881-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLAN",
        "first_name": "JEFFREY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD-13422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "572835-03",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA BILLING NUMBER",
            "identifier": "0000254938",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kamuela, HI

Sources for this page

Verify at the official NPI Registry.