Market Street Clinic, Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

MD-2877 Issued in HI

Legal business name

MARKET STREET CLINIC, INC.

Practice address

53A N Market St
Wailuku, HI 96793-1719

Phone

(808) 244-0007

Fax

(808) 244-8011

NPI assigned

Jul 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Chris Alan Boulange, M.D.

Title

President/General Practitioner

Phone

(808) 244-0007

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Ray, PA-C

  • Physician Assistant
  • Makawao, HI
  • NPI 1366492860
  NPD (past)

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1275798928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53A N MARKET ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931719",
            "telephone_number": "808-244-0007",
            "fax_number": "808-244-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53A N MARKET ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931719",
            "telephone_number": "808-244-0007",
            "fax_number": "808-244-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARKET STREET CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "BOULANGE",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT/GENERAL PRACTITIONER",
        "authorized_official_telephone_number": "808-244-0007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "HI",
            "license": "MD-2877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "A21446-8",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08781201",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Ah Lin Marino, LSW
• Mark D Breithaupt PHD Inc
• Mark D Breithaupt PHD LLC
• Mark E Haddad MD Inc
• Amanda Markell, PA-C
• Amanda Marn, M.D.
• Joseph S Martelles Jr.
• Chandra G Martens, M.D.
• Ronald C. Martin, M.D.
• Benjamin A. Martinez, MD

• Health Maintenance Organization in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Health Maintenance Organization in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.