Wailea Medical Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

3915 Issued in HI

Legal business name

WAILEA MEDICAL GROUP LLC

Practice address

161 Wailea Ike PL
#B102
Wailea, HI 96753-6521

Phone

(808) 875-9095

Fax

(808) 875-9098

NPI assigned

Jul 28, 2006

Last updated

Sep 16, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gregory L Park, MDNPI 1861497596

Title

M.D.

Phone

(808) 875-9095

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gregory Park, M.D.

  • Internal Medicine Physician
  • Wailuku, HI
  • NPI 1861497596
  Medicare reassignment Care Compare group NPD Authorized official
• Maria Teresa David, D.O.

  • Internal Medicine Physician
  • St Augustine, FL
  • NPI 1013914787

  HI

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442361600000",
    "number": "1497769988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 WAILEA IKE PL",
            "address_2": "B-102",
            "city": "WAILEA",
            "state": "HI",
            "postal_code": "967536521",
            "telephone_number": "808-875-9095",
            "fax_number": "808-875-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 WAILEA IKE PL",
            "address_2": "#B102",
            "city": "WAILEA",
            "state": "HI",
            "postal_code": "967536521",
            "telephone_number": "808-875-9095",
            "fax_number": "808-875-9098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAILEA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2015-09-16",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "808-875-9095",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "3915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Telerad of Hi Account Management LLC
• Danielle Marie Tevis, RBT
• Theraputic Fusion: Physical Therapy & Wellness, LLC
• Courtney Lea Truax, NP, DNP
• Jailanie Canonizado Valera
• Wailea Pharmacy LLC (Wailea Pharmacy)
• Rebecca L Zeuch, LMT

• Internal Medicine Physician in Wailea, HI
• Providers in Wailea, HI by specialty
• Internal Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.