NPIMap

Ko Olauloa Health Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Kahuku, HI

NPI 1528026952 · NPPES record last updated Jul 5, 2022

Key facts

NPI
1528026952
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
KO OLAULOA HEALTH CENTER
Practice address
56-119 Pualalea St.
Kahuku, HI 96731
Phone
(808) 293-9231
Fax
(808) 293-5390
NPI assigned
May 3, 2006
Organization subpart
No

Authorized official

Name
Terrence H Aratani
Title
Ceo
Phone
(808) 792-3840

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 1

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

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners 33

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

View all 33

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in HI

Federally qualified health center certification: CCN 121842

Legal name
KO OLAULOA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 23, 2011
Last certification
Feb 23, 2011
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Oct 10, 2003 in HI
Enrollment address
54-316 Kamehameha Hwy
Ste 6&7
Hauula, HI 96717-9539

Federally qualified health center certification: CCN 121843

Legal name
KO OLAULOA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 23, 2011
Last certification
Feb 23, 2011
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Oct 10, 2003 in HI
Enrollment address
56-119 Pualalea St
Kahuku, HI 96731-2052

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Anela Olevao
Individual 		Corporate Director
Board Secretary		 Oct 1, 2021
Donna Ching
Individual 		Corporate Director
Board Treasurer		 Oct 1, 2021
Paula Ogimi
Individual 		Corporate Director
Board Member		 Oct 1, 2021
Judy Fomin
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Corporate Director Jan 1, 2015
Terrence Aratani
Individual 		Corporate Officer
Ceo		 Jan 1, 2011
Operational/Managerial Control
Ceo		 Jan 1, 2011 100%
Corporate Officer
Ceo		 Apr 1, 2015
W-2 Managing Employee
Ceo		 Apr 1, 2015
Operational/Managerial Control
Ceo		 Apr 1, 2015
Melissa Primacio
Individual 		Corporate Director
Board Member		 Jan 1, 2014
Corporate Director
Board Vice President		 Jan 1, 2014
Joe Wilson
Individual 		Corporate Director
Board President		 Oct 1, 2021
Angelique Solomon
Individual 		Corporate Director Oct 1, 2010
Corporate Director Jan 1, 2011
Isabella Gary
Individual 		Corporate Officer
Chief Operations Officer		 Oct 1, 2021
Zachery Johnson
Individual 		Corporate Officer
Chief Financial Officer		 Aug 16, 2021
Sonny-Jean Preston
Individual 		Corporate Director
Board Member		 Dec 1, 2021
Danielle T W Lum
Individual 		Corporate Officer
Chief Medical Officer		 Feb 3, 2020
Isabella Walker
Individual 		Corporate Director
Board Member		 Apr 1, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050112001130 HI Part B Supplier - Clinic/Group Practice 0941259394 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
Practice locations: Kahuku, HI; Hauula, HI
O20110218000884 HI Part a Provider - Federally Qualified Health Center (FQHC) 0941259394 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hauula, HI
O20110223001145 HI Part a Provider - Federally Qualified Health Center (FQHC) 0941259394 Practice locations: Kahuku, HI

National Provider Directory

Locations

56-119 Pualalea St
Kahuku, HI 96731
Phone (808) 293-9231

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X HI Yes

Addresses

Primary practice location

56-119 Pualalea St.
Kahuku, HI 96731

Mailing address

PO Box 395
Kahuku, HI 96731
Phone (808) 293-9231

Other identifiers

IdentifierTypeStateIssuer
00C0263800OtherHIKALAMA NIHEU, MD - HMSA (PUALALEA)
00F0052461OtherHIHARRY ASHE, MD - HMSA
00G00228457OtherHIMIRIAM CHANG, MD - HMSA (PUALALEA)
50178505MedicaidHI
00E0228451OtherHIMIRIAM CHANG, MD - HMSA
00F0228459OtherHIMIRIAM CHANG, MD - HMSA (HAUULA)
00G0052469OtherHIHARRY ASHE, MD - HMSA (HAUULA)
08802105MedicaidHI
581977MedicaidHI
00A0250603OtherHIKCHWC - HMSA
00C0228910OtherHINATIVIDAD HOPEWELL - HMSA
00E0228915OtherHINATIVIDAD HOPEWELL, APRN - HMSA (PUALALEA)
00H0052467OtherHIHARRY ASHE, MD - HMSA (PUALALEA)
55384302MedicaidHI
00D0228918OtherHINATIVIDAD HOPEWELL, APRN - HMSA (HAUULA)
50104005MedicaidHI
00A0244754OtherHIBRENDA HARPER, APRN-HMSA
00J0205359OtherHIDOUGLAS SUTHERLAND, MD - HMSA (PUALALEA)
0000250605OtherHIKCHWC - HMSA
00B0214839OtherHIGARY PITT, DPM - HMSA
00B0263802OtherHIKALAMA NIHEU, MD - HMSA (HAUULA)

Other names

  • Ko'olauloa Community Health and Wellness Center, Kahuku Medical Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 5, 2022.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656979200000",
    "number": "1528026952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 395",
            "city": "KAHUKU",
            "state": "HI",
            "postal_code": "96731",
            "telephone_number": "808-293-9231",
            "fax_number": "808-293-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56-119 PUALALEA ST.",
            "city": "KAHUKU",
            "state": "HI",
            "postal_code": "96731",
            "telephone_number": "808-293-9231",
            "fax_number": "808-293-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KO OLAULOA HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A",
        "authorized_official_last_name": "ARATANI",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "808-792-3840"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "HI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KALAMA NIHEU, MD - HMSA (PUALALEA)",
            "identifier": "00C0263800",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARRY ASHE, MD - HMSA",
            "identifier": "00F0052461",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIRIAM CHANG, MD - HMSA (PUALALEA)",
            "identifier": "00G00228457",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50178505",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIRIAM CHANG, MD - HMSA",
            "identifier": "00E0228451",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIRIAM CHANG, MD - HMSA (HAUULA)",
            "identifier": "00F0228459",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARRY ASHE, MD - HMSA (HAUULA)",
            "identifier": "00G0052469",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08802105",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "581977",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KCHWC - HMSA",
            "identifier": "00A0250603",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIVIDAD HOPEWELL - HMSA",
            "identifier": "00C0228910",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIVIDAD HOPEWELL, APRN - HMSA (PUALALEA)",
            "identifier": "00E0228915",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARRY ASHE, MD - HMSA (PUALALEA)",
            "identifier": "00H0052467",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55384302",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIVIDAD HOPEWELL, APRN - HMSA (HAUULA)",
            "identifier": "00D0228918",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50104005",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRENDA HARPER, APRN-HMSA",
            "identifier": "00A0244754",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOUGLAS SUTHERLAND, MD - HMSA (PUALALEA)",
            "identifier": "00J0205359",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KCHWC - HMSA",
            "identifier": "0000250605",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GARY PITT, DPM - HMSA",
            "identifier": "00B0214839",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KALAMA NIHEU, MD - HMSA (HAUULA)",
            "identifier": "00B0263802",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ko'olauloa Community Health and Wellness Center, Kahuku Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kahuku, HI

All providers in Kahuku, HI · Federally Qualified Health Center (FQHC) in Hawaii

Sources for this page

Verify at the official NPI Registry.