NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

Doing business as Kaiser Koolau Clinic Laboratory

  • Clinical Medical Laboratory
  • Kaneohe, HI
National Provider Identifier
1568477016
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
12D0619452 Issued in HI
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Doing business as
Kaiser Koolau Clinic Laboratory
Practice address
45-602 Kamehameha Hwy
Kaneohe, HI 96744-2017
Phone
(808) 432-3855
Fax
(808) 432-3859
NPI assigned
Jul 30, 2006
Last updated
Mar 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Authorized official

Name
James G. Adams Jr.
Title
Executive Director, Finance Leader
Phone
(808) 286-6758

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 12D0619452 HI Primary

Addresses

Primary practice location

45-602 Kamehameha Hwy
Kaneohe, HI 96744-2017

Mailing address

711 Kapiolani Blvd
Billing Department
Honolulu, HI 96813-5214
Phone (808) 432-5340

Other identifiers 1

IdentifierTypeStateIssuer
549925-01MedicaidHI

Other names 1

  • Kaiser Koolau Clinic Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000948 HI Part B Supplier - Clinic/Group Practice 1850205360 Receives reassigned benefits from 208 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20061030000109 HI Part B Supplier - Independent Clinical Laboratory 1850205360 18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kapolei, HI; Waipahu, HI; Wailuku, HI; Waianae, HI; Lihue, HI; Lahaina, HI; Kihei, HI; Kamuela, HI…

Other NPIs on the same Medicare enrollment 33

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

View all 33

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D0619452Kaiser Permanente Koolau Medical Office Lab45-602 Kamehameha Highway, Kaneohe, HI 96744ComplianceDec 26, 2027
12D0911706Kaiser Permanente Koolau Medical Office PPMP45-602 Kamehameha Hwy, Kaneohe, HI 96744Provider-performed microscopyFeb 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation HLTH379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1568477016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 KAPIOLANI BLVD",
            "address_2": "BILLING DEPARTMENT",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135214",
            "telephone_number": "808-432-5340",
            "fax_number": "808-432-5239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45-602 KAMEHAMEHA HWY",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967442017",
            "telephone_number": "808-432-3855",
            "fax_number": "808-432-3859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, FINANCE LEADER",
        "authorized_official_telephone_number": "808-286-6758",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "HI",
            "license": "12D0619452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "549925-01",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kaiser Koolau Clinic Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Koolau Clinic Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kaneohe, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.