Individual provider Active NPI

Stephen Ken Miyasato, MD

  • Internal Medicine Physician
  • Aiea, HI
National Provider Identifier
1477536563
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD 4730 Issued in HI
Practice address
99-128 Aiea HTS Dr
Ste 105
Aiea, HI 96701-3916
Phone
(808) 487-9922
Fax
(808) 483-6841
NPI assigned
Nov 22, 2005
Last updated
Oct 20, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD 4730 HI Primary

Addresses

Primary practice location

99-128 Aiea HTS Dr
Ste 105
Aiea, HI 96701-3916

Mailing address

99-128 Aiea HTS Dr
Ste 105
Aiea, HI 96701-3916
Phone (808) 487-9922

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
I20120402000215 HI Practitioner - Internal Medicine 8325208168 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Hawaii John a. Burns School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians

Practice addresses (Care Compare)

1380 Lusitana St
Honolulu, HI 96813-2448

1401 S Beretania St
Suite 350
Honolulu, HI 96814-1871
Phone (808) 941-2244

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 4730HIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Queens Medical Center CurrentSince Jun 21, 2021 Accepting new patients
The Queen's Medical Center CurrentSince Jun 21, 2021 Accepting new patients
Queens University Medical Group CurrentSince Apr 22, 2022 Accepting new patients

Locations

98-1247 Kaahumanu St
Ste 315
Aiea, HI 96701
Phone 8085246115519

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

550 S Beretania St
Ste 300
Honolulu, HI 96813
Phone (808) 536-3773

550 S Beretania St
Ste 404
Honolulu, HI 96813
Phone (808) 691-8897

Organizations & group practices 4

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 8

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": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1477536563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99-128 AIEA HTS DR",
            "address_2": "STE 105",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967013916",
            "telephone_number": "808-487-9922",
            "fax_number": "808-483-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99-128 AIEA HTS DR",
            "address_2": "STE 105",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967013916",
            "telephone_number": "808-487-9922",
            "fax_number": "808-483-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYASATO",
        "first_name": "STEPHEN",
        "middle_name": "KEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MD 4730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

Verify at the official NPI Registry.