Carol Ann Iadeluca-Myrianthis, PT, PSYD

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

474 Issued in HI

Practice address

15-2866 Government Main Road
Pahoa Village Center
Pahoa, HI 96778

Phone

(808) 965-0880

Fax

(808) 965-0770

NPI assigned

Aug 13, 2006

Sex

Female

Sole proprietor

No

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.

• Kinesis Hawaii Inc.

  • Physical Therapy Clinic/Center
  • Pahoa, HI
  • NPI 1831371830

  HI

  Medicare reassignment Care Compare group

Specialty

Physical Therapist in Private Practice

Education

Other, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kinesis Hawaii Inc. 2 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2008.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1477565745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 ALAWAENA ST",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967203506",
            "telephone_number": "808-959-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15-2866 GOVERNMENT MAIN ROAD",
            "address_2": "PAHOA VILLAGE CENTER",
            "city": "PAHOA",
            "state": "HI",
            "postal_code": "96778",
            "telephone_number": "808-965-0880",
            "fax_number": "808-965-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IADELUCA-MYRIANTHIS",
        "first_name": "CAROL",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PT, PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA  KA'U",
            "identifier": "A19867",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA  PAHOA",
            "identifier": "D19861",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01853401",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01853402",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shiala Holland
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• Angelina T.M Horner, PHD
• Bryan Houston, LCSW
• Kerry Hubbell, L.M.T.
• Carrie Ip, MD
• Ivaz LLC
• J & W Tours and Taxi
• Stephanie Joerke, L.M.T.
• Eredulin Vigilla Julian

• All providers in Pahoa, HI
• Physical Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.