Active NPI
Daniel A Debaca, O.D.
- Optometrist
- Hilo, HI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OD-874
- Practice address
- 1292 Waianuenue Ave
Hilo, HI 96720-1228 - Phone
- (808) 934-4000
- NPI assigned
- Sep 28, 2006
- Last updated
- May 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT12499TPL | CA | |
| Optometrist | 152W00000X | OD-874 | HI | Primary |
Addresses
Primary practice location
1292 Waianuenue Ave
Hilo, HI 96720-1228
Mailing address
1292 Waianuenue Ave
Hilo, HI 96720-1228
Phone (808) 934-4000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in HI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- International American University at Puerto Rico - School of Optometry, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1292 Waianuenue Ave
Hilo, HI 96720-1228
Phone (808) 934-4000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT12499TPL | CA | MD | Optometrist |
| OD-874 | HI | MD | Optometrist |
| 12499 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hawaii Permanente Medical Group Inc | Current | Accepting new patients | |
| Raj U. Dugel MD Inc | Past | Accepting new patients |
Locations
1292 Waianuenue Ave
Hilo, HI 96720
Phone (808) 334-4400
3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205
711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Health Maintenance Organization
- Honolulu, HI
- NPI 1710945969
-
- Specialist
- Torrance, CA
- NPI 1194911594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620777600000",
"number": "1568554640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1292 WAIANUENUE AVE",
"city": "HILO",
"state": "HI",
"postal_code": "967201228",
"telephone_number": "808-934-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1292 WAIANUENUE AVE",
"city": "HILO",
"state": "HI",
"postal_code": "967201228",
"telephone_number": "808-934-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBACA",
"first_name": "DANIEL",
"middle_name": "A",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2021-05-12",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT12499TPL",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "HI",
"license": "OD-874",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "1292 Waianuenue Ave",
"city": "Hilo",
"state": "HI",
"country_code": "US",
"postal_code": "967201228",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.