NPIMap

Organization Active NPI

Advanced Psychiatric Therapeutics

  • Psychiatry Physician
  • Honolulu, HI
National Provider Identifier
1285920595
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
15632 Issued in HI
Legal business name
ADVANCED PSYCHIATRIC THERAPEUTICS
Practice address
1164 Bishop St Ste 1611
Honolulu, HI 96813-2816
Phone
(808) 261-7792
Fax
(808) 792-0034
NPI assigned
Jun 24, 2011
Last updated
Sep 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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

Authorized official

Name
Dr. Jeremy D Roberts, MDNPI 1598958969
Title
President
Phone
(808) 261-7792

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
Psychiatry Physician 2084P0800X 15632 HI Primary

Addresses

Primary practice location

1164 Bishop St Ste 1611
Honolulu, HI 96813-2816

Mailing address

1164 Bishop St Ste 1611
Honolulu, HI 96813-2816
Phone (808) 261-7792

Other practice location 1

91-2301 Fort Weaver Rd
Ewa Beach, HI 96706-3602
Phone (808) 664-3744

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120215000407 HI Part B Supplier - Clinic/Group Practice 0042478414 Receives reassigned benefits from 17 practitioners
Practice locations: Kapolei, HI; Kailua, HI; Honolulu, HI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D2095677Advanced Psychiatric Therapeutics LLC1164 Bishop St Ste 1611, Honolulu, HI 96813Certificate of waiverMay 7, 2027

National Provider Directory

National Provider Directory

Locations

1164 Bishop St
Ste 1611
Honolulu, HI 96813
Phone (808) 261-7792

4211 Waialae Ave
Ste 203
Honolulu, HI 96816
Phone (808) 261-7792

40 Aulike St
Ste 312
Kailua, HI 96734
Phone (808) 261-7792

91-1010 Shangrila St
Ste 203
Kapolei, HI 96707
Phone (808) 261-7792

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": "1308873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569456000000",
    "number": "1285920595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1164 BISHOP ST STE 1611",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132816",
            "telephone_number": "808-261-7792",
            "fax_number": "808-792-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1164 BISHOP ST STE 1611",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132816",
            "telephone_number": "808-261-7792",
            "fax_number": "808-792-0034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "91-2301 Fort Weaver Rd",
            "address_purpose": "LOCATION",
            "city": "Ewa Beach",
            "state": "HI",
            "postal_code": "967063602",
            "country_code": "US",
            "telephone_number": "808-664-3744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED PSYCHIATRIC THERAPEUTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-24",
        "last_updated": "2019-09-26",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-261-7792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "HI",
            "license": "15632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.