Organization Active NPI

Ultracare Diagnostic Imaging, LLC

  • Radiology Clinic/Center
  • Kailua, HI
National Provider Identifier
1558770651
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
ULTRACARE DIAGNOSTIC IMAGING, LLC
Practice address
122 Oneawa St Ste 102
Kailua, HI 96734-2524
Phone
(808) 354-3510
NPI assigned
Aug 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Authorized official

Name
Deborah Hazelbaker, RDMSNPI 1477782274
Title
Owner
Phone
(808) 354-3510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

122 Oneawa St Ste 102
Kailua, HI 96734-2524

Mailing address

122 Oneawa St Ste 102
Kailua, HI 96734-2524
Phone (808) 354-3510

Other practice location 1

425 G St
Suite 620
Anchorage, AK 99501-2140
Phone (907) 538-4139

Other identifiers 1

IdentifierTypeStateIssuer
1619101MedicaidAK

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL HONOLULU Direct
CONNECT URL HONOLULU Direct

National Provider Directory

National Provider Directory

Locations

4050 Lake Otis Pkwy
Ste 10
Anchorage, AK 99508

425 G St
Ste 620
Anchorage, AK 99501
Phone (907) 538-4139

44539 Sterling Hwy
Ste 108
Soldotna, AK 99669
Phone (907) 538-4139

122 Oneawa St
Ste 102
Kailua, HI 96734
Phone (808) 354-3510

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1558770651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 ONEAWA ST STE 102",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342524",
            "telephone_number": "808-354-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 ONEAWA ST STE 102",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342524",
            "telephone_number": "808-354-3510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 G St",
            "address_2": "Suite 620",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995012140",
            "country_code": "US",
            "telephone_number": "907-538-4139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ULTRACARE DIAGNOSTIC IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-04",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "HAZELBAKER",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-354-3510",
        "authorized_official_credential": "RDMS"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619101",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "HONOLULU",
            "affiliation": "N",
            "endpointDescription": "1558770651",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1009 Kapiolani Blvd Apt 4707",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "968142189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "HONOLULU",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1009 Kapiolani Blvd Apt 4707",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "968142189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kailua, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.