Active NPI
Errol T Buntuyan, MD
- Family Medicine Physician
- Wailuku, HI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD-14515
- Practice address
- 55 Maui Lani Pkwy
Wailuku, HI 96793-2416 - Phone
- (808) 243-6050
- NPI assigned
- Aug 23, 2005
- Last updated
- Jun 28, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD-14515 | HI | Primary |
| Family Medicine Physician | 207Q00000X | 038503 | CT |
Addresses
Primary practice location
55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Mailing address
55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001385039 | Medicaid | CT | |
| 0000270777 | Other | HI | HMSA BILLING NUMBER |
| 612772-02 | Medicaid | HI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Un of California, Irvine, College of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000
1100 N Palm Canyon Dr
Suite 208
Palm Springs, CA 92262-4426
Phone (951) 353-2000
75036 Gerald Ford Dr
Palm Desert, CA 92211-2080
Phone (866) 883-0119
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038503 | CT | MD | Family Medicine Physician |
| MD-14515 | HI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients |
Locations
3733 San Dimas St
Ste 101
Bakersfield, CA 93301
Phone (800) 353-5400
393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914
10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000
Organizations & group practices 3
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.
-
- Health Maintenance Organization
- Riverside, CA
- NPI 1316979834
-
- Health Maintenance Organization
- Santa Clarita, CA
- NPI 1316409410
-
- Health Maintenance Organization
- Bakersfield, CA
- NPI 1861424376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687910400000",
"number": "1316930548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 MAUI LANI PKWY",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967932416",
"telephone_number": "808-243-6050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 MAUI LANI PKWY",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967932416",
"telephone_number": "808-243-6050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNTUYAN",
"first_name": "ERROL",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2023-06-28",
"certification_date": "2021-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "HI",
"license": "MD-14515",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CT",
"license": "038503",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001385039",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA BILLING NUMBER",
"identifier": "0000270777",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "612772-02",
"state": "HI"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "Southern California Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "10800 Magnolia Ave",
"city": "Riverside",
"state": "CA",
"country_code": "US",
"postal_code": "925053043",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Wailuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.