Individual provider Active NPI

Kimble C. Poon, MD

  • Cardiovascular Disease Physician
  • Wailuku, HI
National Provider Identifier
1376747410
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
15789 Issued in HI
Practice address
80 Mahalani St
Wailuku, HI 96793-2531
Phone
(808) 243-6000
Fax
(000) 000-0000
NPI assigned
Jun 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X 15789 HI
Cardiovascular Disease Physician 207RC0000X 15789 HI Primary

Addresses

Primary practice location

80 Mahalani St
Wailuku, HI 96793-2531

Mailing address

80 Mahalani St
Wailuku, HI 96793-2531
Phone (808) 243-6000

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
I20101220000280 HI Practitioner - Cardiovascular Disease (Cardiology) 6406999200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
JS Weill Medical College, Cornell University, 2004
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

221 Mahalani St
Wailuku, HI 96793-2526
Phone (808) 244-9056

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

401 Kamokila Blvd
Kapolei, HI 96707-5607
Phone (808) 432-3600

4366 Kukui Grove St
Suite 101
Lihue, HI 96766-2006
Phone (808) 246-5600

55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050

67-1185 Mamalahoa Hwy
Kamuela, HI 96743-7304
Phone (808) 881-4500

80 Mahalani St
Wailuku, HI 96793-2531
Phone (808) 243-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15789HIMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Feb 2, 2015 Accepting new patients

Locations

1190 Waianuenue Ave
Hilo, HI 96720
Phone (808) 932-3000

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

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

80 Mahalani St
Wailuku, HI 96793
Phone (808) 243-6000

221 Mahalani St
Wailuku, HI 96793
Phone (808) 242-2290

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1376747410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932531",
            "telephone_number": "808-243-6000",
            "fax_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932531",
            "telephone_number": "808-243-6000",
            "fax_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POON",
        "first_name": "KIMBLE",
        "middle_name": "C.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "HI",
            "license": "15789",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "HI",
            "license": "15789",
            "primary": true
        }
    ],
    "identifiers": [],
    "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": "80 Mahalani St",
            "city": "Wailuku",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967932531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.