Organization Active NPI

R. Craig Netzer MD Inc

  • Internal Medicine Physician
  • Lihue, HI
National Provider Identifier
1316012289
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD11719 Issued in HI
Legal business name
R. CRAIG NETZER MD INC
Practice address
4473 Pahee St
Ste O
Lihue, HI 96766-2037
Phone
(808) 246-2002
Fax
(808) 246-2700
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
Dr. Craig Netzer, MD
Title
Medical Doctor
Phone
(808) 246-2002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD11719 HI Primary

Addresses

Primary practice location

4473 Pahee St
Ste O
Lihue, HI 96766-2037

Mailing address

4473 Pahee St
Ste L
Lihue, HI 96766-2037
Phone (808) 632-0200

Other identifiers 2

IdentifierTypeStateIssuer
50101602MedicaidHI
HMSA BC HAWAIIOtherHI00A0232684

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041119000517 HI Part B Supplier - Clinic/Group Practice 5092770982 Receives reassigned benefits from 1 practitioner
Practice locations: Lihue, 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
12D1036113R Craig Netzer MD Inc4473 Pahee St Ste O, Room 1 and Room 2, Lihue, HI 96766Certificate of waiverJan 19, 2027

National Provider Directory

National Provider Directory

Locations

4473 Pahee St
Ste 0
Lihue, HI 96766
Phone (808) 246-2002

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1316012289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4473 PAHEE ST",
            "address_2": "STE L",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967662037",
            "telephone_number": "808-632-0200",
            "fax_number": "808-632-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4473 PAHEE ST",
            "address_2": "STE O",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967662037",
            "telephone_number": "808-246-2002",
            "fax_number": "808-246-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. CRAIG NETZER MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "NETZER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "808-246-2002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MD11719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50101602",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "00A0232684",
            "identifier": "HMSA BC HAWAII",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lihue, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; 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.