NPIMap

Individual provider Active NPI

Michael Kalani Kenmun Tom, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Honolulu, HI
National Provider Identifier
1487997516
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
18360 Issued in HI
Practice address
550 S Beretania St Ste 601
Honolulu, HI 96813-2423
Phone
(808) 691-8877
Fax
(808) 691-8875
NPI assigned
Mar 27, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18360 HI
Student in an Organized Health Care Education/Training Program 390200000X HI
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 18360 HI Primary

Addresses

Primary practice location

550 S Beretania St Ste 601
Honolulu, HI 96813-2423

Mailing address

550 S Beretania St Ste 601
Honolulu, HI 96813-2423
Phone (808) 691-8877

Other practice location 1

1356 Lusitana St., Ste. 510
Honolulu, HI 96813-4902
Phone (808) 586-2890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160705001607 HI Practitioner - Internal Medicine 6204128697 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Hawaii John a. Burns School of Medicine, 2013
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

Hospital & facility affiliations

  • Careresource Hawaii Home health agency, Honolulu, HI, CCN 127013
  • Home Health Honolulu Home health agency, Honolulu, HI, CCN 127025
  • Adventist Health Home Care Services Home health agency, Kaneohe, HI, CCN 127017
  • Bayada Home Health Care Home health agency, Honolulu, HI, CCN 127310
  • Bristol Hospice - Hawaii, LLC Hospice, Honolulu, HI, CCN 121508
  • Malama Ola Health Services LLC Hospice, Honolulu, HI, CCN 121511
  • St Francis Hospice Hospice, Honolulu, HI, CCN 121500
  • Islands Hospice Hospice, Honolulu, HI, CCN 121509

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18360HIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Queens Medical Center CurrentSince Jul 1, 2016 Accepting new patients
The Queen'S Medical Center CurrentSince Jul 1, 2016 Accepting new patients
Queens University Medical Group CurrentSince Apr 22, 2022 Accepting new patients

Locations

98-1079 Moanalua Rd
Aiea, HI 96701
Phone (808) 485-4301

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

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

550 S Beretania St
Ste 601
Honolulu, HI 96813
Phone (808) 691-8877

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

550 S Beretania St
Ste 510
Honolulu, HI 96813
Phone (808) 536-3773

Interoperability endpoints

  • Direct secure messaging: michael.tom.1@19917.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 10

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": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1487997516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S BERETANIA ST STE 601",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132423",
            "telephone_number": "808-691-8877",
            "fax_number": "808-691-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S BERETANIA ST STE 601",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132423",
            "telephone_number": "808-691-8877",
            "fax_number": "808-691-8875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1356 Lusitana St., Ste. 510",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968134902",
            "country_code": "US",
            "telephone_number": "808-586-2890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOM",
        "first_name": "MICHAEL",
        "middle_name": "KALANI KENMUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "18360",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "HI",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "HI",
            "license": "18360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.