NPIMap

Organization Active NPI

Community Clinic of Maui, Inc.

  • Community Health Clinic/Center
  • Lahaina, HI
National Provider Identifier
1619721263
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COMMUNITY CLINIC OF MAUI, INC.
Practice address
10 Hoohui Rd
Lahaina, HI 96761-9256
Phone
(808) 871-7772
Fax
(808) 872-4029
NPI assigned
Apr 11, 2024
Organization subpart
Yes
Parent organization
COMMUNITY CLINIC OF MAUI, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Authorized official

Name
John R VazNPI 1952556201
Title
Ceo
Phone
(808) 871-7772

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary
Federally Qualified Health Center (FQHC) 261QF0400X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

10 Hoohui Rd
Lahaina, HI 96761-9256

Mailing address

1881 Nani St
Wailuku, HI 96793-1811
Phone (808) 871-7772

Other names 1

  • Malama I Ke Ola Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000740 HI Part B Supplier - Clinic/Group Practice 2466365440 Receives reassigned benefits from 32 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lahaina, HI; Wailuku, HI; Kihei, HI; Kahului, HI
O20240724002992 HI Part A Provider - Federally Qualified Health Center (FQHC) 2466365440 Practice locations: Lahaina, HI

Federally qualified health center certification: CCN 121015

Legal name
COMMUNITY CLINIC OF MAUI INC
Doing business as
MALAMA I KE OLA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2024
Last certification
Jun 7, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 2024 in HI
Enrollment address
10 Hoohui Rd
Ste 305
Lahaina, HI 96761-9259

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Community Clinic of Mau8 organizations share this tax ID, including this one
Part of
Community Clinic of Mau

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Nicole M.N. Galicinao Individual Corporate DirectorBoard Member Oct 19, 2021
Vanessa Medeiros Individual Corporate DirectorBoard Member Nov 1, 2010
Margaret Batangan Individual Corporate Director Nov 19, 2024
Amy Schliftman Individual Corporate Director Sep 23, 2025
Lorrin Pang Individual Corporate DirectorBoard Member Nov 1, 2010
Andrea Poling Individual Corporate DirectorBoard Member Apr 18, 2023
John Vaz Individual Corporate OfficerChief Executive Officer Jul 1, 2022
W-2 Managing EmployeeChief Executive Officer Jul 1, 2022
Gerard F Livaudais Individual Corporate DirectorBoard Member Jul 18, 2023
Sharon M Lund Individual Corporate DirectorBoard Member Dec 3, 2018
Charles Keoho Individual Corporate DirectorBoard Member Mar 1, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1619721263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 NANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931811",
            "telephone_number": "808-871-7772",
            "fax_number": "808-872-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HOOHUI RD",
            "city": "LAHAINA",
            "state": "HI",
            "postal_code": "967619256",
            "telephone_number": "808-871-7772",
            "fax_number": "808-872-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CLINIC OF MAUI, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CLINIC OF MAUI, INC.",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "VAZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "808-871-7772"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malama I Ke Ola Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lahaina, HI

Sources for this page

Verify at the official NPI Registry.