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

Organization subpart

No

Name

Mr. Gregory L Park, MDNPI 1861497596

Title

M.D.

Phone

(808) 875-9095

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Park, M.D.

  • Internal Medicine Physician
  • Wailuku, HI
  • NPI 1861497596

  HI, Internal Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Maria Teresa David, D.O.

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

  HI, Internal Medicine

  Medicare reassignment Care Compare group NPD

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 16, 2015.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045506-02",
            "state": "HI"
        }
    ],
    "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
• Rebecca L Zeuch, LMT

• All providers in Wailea, HI
• 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.