Individual provider Active NPI

Theresa S. Devere, MD

  • Dermatology Physician
  • Honolulu, HI
National Provider Identifier
1316952823
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD-15553 Issued in HI
Practice address
2828 Paa St
Honolulu, HI 96819-4430
Phone
(808) 432-5770
NPI assigned
Jul 31, 2006
Last updated
Jun 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD-15553 HI Primary
Dermatology Physician 207N00000X MD22922 OR

Addresses

Primary practice location

2828 Paa St
Honolulu, HI 96819-4430

Mailing address

2828 Paa St
Honolulu, HI 96819-4430
Phone (808) 432-5770

Other identifiers 1

IdentifierTypeStateIssuer
228920MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101115000033 HI Practitioner - Dermatology 0345138715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Baylor College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hawaii Permanente Medical Group IncGroup PAC ID 7618880667, 705 clinicians

Practice addresses (Care Compare)

1010 Pensacola St
Honolulu, HI 96814-2118
Phone (808) 432-2000

2828 Paa St
Honolulu, HI 96819-4430
Phone (808) 243-6050

3288 Moanalua Rd
Honolulu, HI 96819-1469
Phone (808) 432-0000

74 -517 Honokohau St
Kailua Kona, HI 96740-2715
Phone (808) 432-0000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions18
Skin biopsy16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD-15553HIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Jul 11, 2010 Accepting new patients
Oregon Health Sciences University Department of Ophthalmology Past Accepting new patients

Locations

1010 Pensacola St
Honolulu, HI 96814
Phone (808) 432-2000

2828 Paa St
Honolulu, HI 96819
Phone (808) 432-5700

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 432-8000

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1316952823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 PAA ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968194430",
            "telephone_number": "808-432-5770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 PAA ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968194430",
            "telephone_number": "808-432-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVERE",
        "first_name": "THERESA",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "HI",
            "license": "MD-15553",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD22922",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228920",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2828 Paa St",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "968194430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.