Individual provider Active NPI

Theron Ogata, P.T.

  • Physical Therapist
  • Kailua Kona, HI
National Provider Identifier
1437292240
Registry record updated Feb 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-1906 Issued in HI
Practice address
75-5699 Kopiko St
Kailua Kona, HI 96740-1668
Phone
(808) 329-7744
NPI assigned
Feb 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-1906 HI Primary

Addresses

Primary practice location

75-5699 Kopiko St
Kailua Kona, HI 96740-1668

Mailing address

75-5699 Kopiko St
Kailua Kona, HI 96740-1668
Phone (808) 329-7744

Other identifiers 1

IdentifierTypeStateIssuer
572265-02MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071210000210 HI Practitioner - Physical Therapist in Private Practice 3476642729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Club Rehab, Inc.Group PAC ID 0749193977, 11 clinicians

Practice addresses (Care Compare)

75 -5699 Kopiko St
Kailua Kona, HI 96740-3651
Phone (808) 329-7744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Club Rehab, Inc. Physical Therapist CurrentSince Mar 27, 2002 Accepting new patients

Locations

75-5699 Kopiko St
Kailua Kona, HI 96740
Phone (808) 329-7744

73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740

79-7422 Mamalahoa Hwy
Kealakekua, HI 96750
Phone (808) 322-8400

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202428800000",
    "number": "1437292240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5699 KOPIKO ST",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401668",
            "telephone_number": "808-329-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5699 KOPIKO ST",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401668",
            "telephone_number": "808-329-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGATA",
        "first_name": "THERON",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "PT-1906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "572265-02",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.