Jacob Wiley Blickenstaff, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD-20256 Issued in HI

Practice address

1329 Lusitana St Ste 604
Honolulu, HI 96813-2431

Phone

(808) 531-1116

NPI assigned

Jul 12, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Anesthesiology

Education

University of California, Irvine, California College of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Koolau Anesthesia Group LLCGroup PAC ID 3274929724, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Castle Hospital, Kailua, HI, CCN 120006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Koolau Anesthesia Group, LLC

  • Anesthesiology Physician
  • Kaneohe, HI
  • NPI 1265184352
  Medicare reassignment Care Compare group NPD
• Island Medical Consultants, LLC

  • Anesthesiology Physician
  • Honolulu, HI
  • NPI 1881965986
  Medicare reassignment NPD
• Hawaii Permanente Medical Group Inc

  • Health Maintenance Organization
  • Honolulu, HI
  • NPI 1710945969
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Castle Medical Center

  • General Acute Care Hospital
  • Kailua, HI
  • NPI 1316937691
  Care Compare affiliation

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

{
    "created_epoch": "1436659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1487038253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 LUSITANA ST STE 604",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 LUSITANA ST STE 604",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132431",
            "telephone_number": "808-531-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLICKENSTAFF",
        "first_name": "JACOB",
        "middle_name": "WILEY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-12",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "HI",
            "license": "MD-20256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Blanton Jr.
• Jesse Blanton, PA-C
• Matthew Blasquez
• Blessin Health LLC
• Pamela Kaye Blessum
• Jacob Samuel Blitstein, DO
• Janci Blodgett, LVN
• Karen Kae Blonigan
• Joseph Robert Bloom, LCSW
• Melissa M Bloom, M.D.

• Anesthesiology Physician in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Anesthesiology Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.