NPIMap

Organization Active NPI

Samuel Mahelona Memorial Hospital

  • Critical Access Hospital
  • Kapa'a, HI
National Provider Identifier
1619038536
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
22-H Issued in HI
Legal business name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Practice address
4800 Kawaihau Road
Kapaa, HI 96746
Phone
(808) 338-9431
Fax
(808) 338-9420
NPI assigned
Dec 13, 2006
Last updated
Nov 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Ms. Rachelle M D Lorenzo
Title
Cfo
Phone
(808) 338-9431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 22-H HI Primary

Addresses

Primary practice location

4800 Kawaihau Road
Kapaa, HI 96746

Mailing address

4800 Kawaihau Road
Kapaa, HI 96746
Phone (808) 338-9431

Other identifiers 1

IdentifierTypeStateIssuer
578601MedicaidHI

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040318000116 HI Part B Supplier - Clinic/Group Practice 1759271216 Receives reassigned benefits from 69 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lihue, HI; Waimea, HI; Koloa, HI; Kapaa, HI; Kalaheo, HI; Eleele, HI
O20061104000580 HI Part A Provider - Critical Access Hospital 1759271216 Receives reassigned benefits from 4 practitioners
Practice locations: Kapaa, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619038536. Details of each certification follow.

Hospital certification: CCN 121306

Legal name
SAMUEL MAHELONA MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 23, 2005
Last certification
Nov 20, 2020
Beds
14
Ownership / control type
State
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1996 in HI
Enrollment address
4800 Kawaihau Rd
Kapaa, HI 96746-1930
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Samuel Mahelona Memorial HospitalCCN 121306 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Samuel Mohelona Memorial9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kurt S Akamine Individual Corporate DirectorBoard Member May 15, 2017
OtherBoard Member May 15, 2017
Lance K Segawa Individual Corporate OfficerRegional Ceo Apr 1, 2018 100%
W-2 Managing EmployeeRegional Ceo Apr 1, 2018 100%
Operational/Managerial ControlRegional Ceo Apr 1, 2018 100%
Laurel K S Loo Individual Corporate DirectorBoard Member May 17, 2017
OtherBoard Memberboard Member May 17, 2017
Tito Villanueva Individual Corporate DirectorBoard Member May 15, 2017
OtherBoard Member May 15, 2017
Donna Okada-Asher Individual Corporate DirectorBoard Member May 15, 2017
OtherBoard Member May 15, 2017
Patrick S Gegen Individual Corporate DirectorBoard Member May 15, 2017
OtherBoard Member May 15, 2017
Hawaii Health Systems Corporation Organization, Honolulu, HI 5% Or Greater Direct Ownership Interest Jul 1, 1996 5%
Stephanie N Iona Individual Corporate DirectorBoard Member May 15, 2017
OtherBoard Member May 15, 2017
Christine M Asato Individual Corporate OfficerRegional Cfo Apr 1, 2018 50%
W-2 Managing EmployeeRegional Cfo Apr 1, 2018 50%
Operational/Managerial ControlRegional Cfo Apr 1, 2018 50%

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 12Z306 Hospital 5% Or Greater Direct Ownership Interest (95%) Jul 1, 1996
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 12M306 Hospital 5% Or Greater Direct Ownership Interest (25%)
Operational/Managerial Control (25%)		 Jan 29, 2010
Jan 29, 2010
Samuel Mahelona Memorial HospitalKapaa, HI, CCN 125029 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 17, 2017
Apr 1, 2015
HHSC - Kauai Region Clinics the Clinic at Port AllenEleele, HI, CCN 123989 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at KapaaKapaa, HI, CCN 123988 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Specialty Clinic at KalaheoKalaheo, HI, CCN 123987 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at KalaheoKalaheo, HI, CCN 123986 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 23, 2020
HHSC - Kauai Region Clinics Urgent Care at PoipuKoloa, HI, CCN 123992 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at LihueLihue, HI, CCN 123985 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020
HHSC - Kauai Region Clinics the Clinic at WaimeaWaimea, HI, CCN 123990 Rural health clinic 5% Or Greater Direct Ownership Interest (95%) Dec 23, 2020

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 34

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 34

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 64

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1619038536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 KAWAIHAU ROAD",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "96746",
            "telephone_number": "808-338-9431",
            "fax_number": "808-338-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 KAWAIHAU ROAD",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "96746",
            "telephone_number": "808-338-9431",
            "fax_number": "808-338-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL MAHELONA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "LORENZO",
        "authorized_official_first_name": "RACHELLE",
        "authorized_official_middle_name": "M D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "808-338-9431",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "HI",
            "license": "22-H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578601",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kapa'a, HI

Sources for this page

Verify at the official NPI Registry.