NPIMap

Organization Active NPI

Samuel Mahelona Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Kapa'a, HI
National Provider Identifier
1508927427
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
22-H Issued in HI
Legal business name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Practice address
4800 Kawaihau Road
Kapaa, HI 96746-1998
Phone
(808) 338-9431
Fax
(808) 338-9420
NPI assigned
Dec 13, 2006
Last updated
Nov 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Ms. Rachelle M D Lorenzo
Title
Cfo
Phone
(808) 338-9431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 22-H HI Primary

Addresses

Primary practice location

4800 Kawaihau Road
Kapaa, HI 96746-1998

Mailing address

4800 Kawaihau Road
Kapaa, HI 96746-1998
Phone (808) 338-9431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200413003183 HI Part A Provider - Critical Access Hospital 1759271216 Practice locations: Kapaa, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508927427. Details of each certification follow.

Hospital certification: CCN 12Z306

Legal name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1996 in HI
Enrollment address
4800 Kawaihau Rd
Kapaa, HI 96746
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Samuel Mahelona Memorial Hospital9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kurt S Akamine Individual Corporate DirectorBoard Member May 15, 2017
Samuel Mahelona Memorial Hospital Organization, Kapaa, HI 5% Or Greater Direct Ownership Interest Jul 1, 1996 95%
Lance K Segawa Individual Corporate OfficerRegional Ceo Apr 1, 2018 100%
W-2 Managing EmployeeRegional Ceo Apr 1, 2018 100%
Operational/Managerial ControlRegional Ceo Apr 1, 2018 100%
Rhonelle Aceret Individual W-2 Managing EmployeeCredentialing Coordinator Nov 1, 2019
Laurel K S Loo Individual Corporate DirectorBoard Member May 17, 2017
Tito Villanueva Individual Corporate DirectorBoard Member May 15, 2017
Donna Okada-Asher Individual Corporate DirectorBoard Member May 15, 2017
Patrick S Gegen Individual Corporate DirectorBoard Member May 15, 2017
Hawaii Health Systems Corporation Organization, Honolulu, HI Corporation 5% Or Greater Direct Ownership Interest Jul 1, 1996 5%
Stephanie N Iona Individual Corporate DirectorBoard Member May 15, 2017
Christine M Asato Individual Corporate OfficerRegional Cfo Apr 1, 2018 50%
W-2 Managing EmployeeRegional Cfo Apr 1, 2018 50%
Operational/Managerial ControlRegional Cfo Apr 1, 2018 50%

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 12M306 Hospital 5% Or Greater Direct Ownership Interest (25%)
Operational/Managerial Control (25%)		 Jan 29, 2010
Jan 29, 2010
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 125029 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 17, 2017
Apr 1, 2015
HHSC - Kauai Region Clinics the Clinic at Port AllenEleele, HI, CCN 123989 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at KapaaKapaa, HI, CCN 123988 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Specialty Clinic at KalaheoKalaheo, HI, CCN 123987 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at KalaheoKalaheo, HI, CCN 123986 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 23, 2020
HHSC - Kauai Region Clinics Urgent Care at PoipuKoloa, HI, CCN 123992 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at LihueLihue, HI, CCN 123985 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at WaimeaWaimea, HI, CCN 123990 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 36

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1508927427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 KAWAIHAU ROAD",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "967461998",
            "telephone_number": "808-338-9431",
            "fax_number": "808-338-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 KAWAIHAU ROAD",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "967461998",
            "telephone_number": "808-338-9431",
            "fax_number": "808-338-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL MAHELONA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "LORENZO",
        "authorized_official_first_name": "RACHELLE",
        "authorized_official_middle_name": "M D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "808-338-9431",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "HI",
            "license": "22-H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kapa'a, HI

Sources for this page

Verify at the official NPI Registry.