Individual provider Active NPI

John Tarnowski

  • Emergency Medicine Physician
  • Honolulu, HI
National Provider Identifier
1417506445
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
AMD-1106 Issued in HI
Practice address
770 Kapiolani Blvd Ste 705
Honolulu, HI 96813-5241
Phone
(808) 597-8778
NPI assigned
Sep 11, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X AMD-1106 HI Primary
Physician Assistant 363A00000X PA58088 CA

Addresses

Primary practice location

770 Kapiolani Blvd Ste 705
Honolulu, HI 96813-5241

Mailing address

770 Kapiolani Blvd Ste 705
Honolulu, HI 96813-5241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, HI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200820000657 CA Practitioner - Physician Assistant 8729404835 Reassigns benefits to 3 organizations
I20220309002579 HI Practitioner - Physician Assistant 8729404835 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
AMD-1106HIMDEmergency Medicine Physician
PA58088CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Single Specialty CurrentSince Nov 23, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Nov 23, 2020 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Aug 1, 2020 Accepting new patients
Petrel Emergency Physicians, a Medical Corporation Single Specialty Past Accepting new patients

Locations

19333 Bear Valley Rd
Ste 106
Apple Valley, CA 92308
Phone (760) 240-5505

18300 US Highway 18
Apple Valley, CA 92307
Phone (760) 424-2311

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

Interoperability endpoints

  • Direct secure messaging: jtarnowski1416169@oc.providencedirect.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1417506445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 KAPIOLANI BLVD STE 705",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 KAPIOLANI BLVD STE 705",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135241",
            "telephone_number": "808-597-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARNOWSKI",
        "first_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "AMD-1106",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58088",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.