Paul R. K. Bacon

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

138 Kinoole St
Hilo, HI 96720-2816

Phone

(808) 933-0599

Fax

(808) 933-0585

NPI assigned

Feb 23, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1407981764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15-2809 MAIKO ST",
            "city": "PAHOA",
            "state": "HI",
            "postal_code": "967789136",
            "telephone_number": "808-933-0598",
            "fax_number": "808-933-0585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 KINOOLE ST",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967202816",
            "telephone_number": "808-933-0599",
            "fax_number": "808-933-0585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "PAUL",
        "middle_name": "R. K.",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "HI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "539372-15",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Case Manager/Care Coordinator in Hilo, HI
• Providers in Hilo, HI by specialty
• Case Manager/Care Coordinator in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.