Individual provider Active NPI

Marc S Emde, MD

  • Emergency Medicine Physician
  • Wailuku, HI
National Provider Identifier
1609819010
Registry record updated Mar 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11179 Issued in HI
Practice address
221 Mahalani St
Wailuku, HI 96793-2526
Phone
(808) 242-2290
NPI assigned
Jun 14, 2006
Last updated
Mar 5, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11179 HI Primary

Addresses

Primary practice location

221 Mahalani St
Wailuku, HI 96793-2526

Mailing address

PO Box 8488
Philadelphia, PA 19101-8488
Phone (805) 563-3011

Other identifiers 1

IdentifierTypeStateIssuer
49627503MedicaidHI

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100429001178 HI Practitioner - Emergency Medicine 0143115758 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11179HIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maui Memorial Emergency Medical Associates Inc Emergency Medicine CurrentSince Jul 7, 2018 Accepting new patients
Lanai Emergency Medical Associates Inc Emergency Medicine CurrentSince Sep 1, 2018 Accepting new patients
The Emergency Group, Inc. Emergency Medicine Past Accepting new patients
Marc S Emde MD Inc Emergency Medicine PastSince Jan 2, 2003 Accepting new patients

Locations

221 Mahalani St
Wailuku, HI 96793
Phone (808) 242-2290

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267747200000",
    "number": "1609819010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8488",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191018488",
            "telephone_number": "805-563-3011",
            "fax_number": "805-564-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932526",
            "telephone_number": "808-242-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMDE",
        "first_name": "MARC",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2010-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "11179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49627503",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.