NPIMap

Organization Active NPI

Pacific Clinic, Inc.

  • Psychologist
  • Kapa'a, HI
National Provider Identifier
1598965253
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY-433 Issued in HI
Legal business name
PACIFIC CLINIC, INC.
Practice address
4566 Ohia St
Kapaa, HI 96746-1646
Phone
(808) 822-5881
Fax
(808) 823-6535
NPI assigned
Jul 20, 2007
Last updated
Jul 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Dr. Robert J Brown, PHDNPI 1326016205
Title
PHD/Owner
Phone
(808) 822-5881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY-433 HI Primary

Addresses

Primary practice location

4566 Ohia St
Kapaa, HI 96746-1646

Mailing address

4-1191 Kuhio Hwy
#289
Kapaa, HI 96746-1674
Phone (808) 822-5881

Other identifiers 1

IdentifierTypeStateIssuer
06530601MedicaidHI

National Provider Directory

National Provider Directory

Locations

4-1191 Kuhio Hwy
#289
Kapaa, HI 96746

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.

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1598965253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4-1191 KUHIO HWY",
            "address_2": "#289",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "967461674",
            "telephone_number": "808-822-5881",
            "fax_number": "808-823-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 OHIA ST",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "967461646",
            "telephone_number": "808-822-5881",
            "fax_number": "808-823-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHD/OWNER",
        "authorized_official_telephone_number": "808-822-5881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "HI",
            "license": "PSY-433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06530601",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kapa'a, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.