NPIMap

Organization Active NPI

Samuel Mahelona Memorial Hospital

  • Nursing Facility/Intermediate Care Facility
  • Kapa'a, HI
National Provider Identifier
1528129442
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
27-N Issued in HI
Legal business name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Practice address
4800 Kawaihau Road
Kapaa, HI 96746
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
Nursing Facility/Intermediate Care Facility 313M00000X 27-N HI Primary

Addresses

Primary practice location

4800 Kawaihau Road
Kapaa, HI 96746

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
592403MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170403000085 HI Part A Provider - Skilled Nursing Facility 1759271216 Practice locations: Kapaa, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528129442. Details of each certification follow.

Skilled nursing facility certification: CCN 125029

Legal name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 15, 1976
Last certification
Nov 22, 2024
Beds
66
Ownership / control type
State
Multi-facility organization
Hawaii Health Systems Corporation
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1996 in HI
Enrollment address
4800 Kawaihau Rd
Kapaa, HI 96746
Nursing home name
SAMUEL MAHELONA MEMORIAL HOSPITAL

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Samuel Mahelona Memorial HospitalCCN 125029 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Jul 15, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6647.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Samuel Mohelona Memorial9 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
Glenda Nogami-Streufert Individual Managing Control - Governing Body Nov 1, 2020
Nicholas P Franklin Individual Operational/Managerial Control Aug 16, 2022
Adp of the SNF Jan 30, 2025
Walter Barnes Individual Managing Control - Governing Body Jan 1, 2023
Samuel Mahelona Memorial Hospital Organization, Kapaa, HI Non-profit 5% Or Greater Direct Ownership Interest Mar 17, 2017 100%
Operational/Managerial Control Apr 1, 2015
Dennis Rowley Individual Managing Control - Governing Body Jul 1, 2023
Theodor Rintel Individual Managing Control - Governing Body Feb 13, 2023
Lance K Segawa Individual Corporate OfficerRegional Chief Officer Apr 1, 2018 100%
Operational/Managerial ControlRegional Chief Executive Officer Apr 1, 2018
Adp of the SNF Jan 29, 2025
Christopher Yuh Individual Managing Control - Governing Body Apr 1, 2024
Donna Okada-Asher Individual Managing Control - Governing Body Dec 7, 2015
Christine M Asato Individual Corporate OfficerRegional Cfo Apr 1, 2018 50%
Operational/Managerial Control Apr 1, 2018
Ernest Kanekoa Individual Managing Control - Governing Body Nov 1, 2020

Owners & managing parties with NPI records 12

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 12Z306 Hospital 5% Or Greater Direct Ownership Interest (95%) Jul 1, 1996
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
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 9

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

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

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": "1528129442",
    "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": "96746",
            "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": "96746",
            "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": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "HI",
            "license": "27-N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "592403",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kapa'a, HI

Sources for this page

Verify at the official NPI Registry.