NPIMap

Organization Active NPI

Koolau Anesthesia Group, LLC

  • Anesthesiology Physician
  • Kaneohe, HI
National Provider Identifier
1265184352
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
KOOLAU ANESTHESIA GROUP, LLC
Doing business as
Koolau Anesthesia Group, LLC
Practice address
44-668 Kuono PL
Kaneohe, HI 96744-2539
Phone
(415) 341-7354
NPI assigned
Jan 20, 2022
Last updated
Jan 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Patrick FujimotoNPI 1548218936
Title
Authorized Official
Phone
(415) 341-7354

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

44-668 Kuono PL
Kaneohe, HI 96744-2539

Mailing address

44-668 Kuono PL
Kaneohe, HI 96744-2539
Phone (415) 341-7354

Other names 1

  • KOOLAU ANESTHESIA GROUP, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220408001242 HI Part B Supplier - Clinic/Group Practice 3274929724 Receives reassigned benefits from 23 practitioners
Practice locations: Honolulu, HI; Kailua, HI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1265184352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44-668 KUONO PL",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967442539",
            "telephone_number": "415-341-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44-668 KUONO PL",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967442539",
            "telephone_number": "415-341-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOLAU ANESTHESIA GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "FUJIMOTO",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "415-341-7354"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KOOLAU ANESTHESIA GROUP, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kaneohe, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.