Individual provider Active NPI

Subodh Mishra

  • Hospitalist Physician
  • Ewa Beach, HI
National Provider Identifier
1639663628
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD-22461 Issued in HI
Practice address
91-2141 Fort Weaver Rd
Ewa Beach, HI 96706-1993
Phone
(808) 691-3000
NPI assigned
Jun 21, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD-22461 HI Primary

Addresses

Primary practice location

91-2141 Fort Weaver Rd
Ewa Beach, HI 96706-1993

Mailing address

91-2141 Fort Weaver Rd
Ewa Beach, HI 96706-1993
Phone (808) 691-3000

Other practice location 1

100 W California Blvd
Pasadena, CA 91105-3010
Phone (626) 421-7733

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220728000096 HI Practitioner - Hospitalist 4486036126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
University of Hawaii John a. Burns School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians

Practice addresses (Care Compare)

1301 Punchbowl St
Honolulu, HI 96813-2499

1380 Lusitana St
Honolulu, HI 96813-2448

91 -2127 Fort Weaver Rd
Ewa Beach, HI 96706-1993
Phone (808) 691-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.05 of 100Reported as apm
Quality
89.81
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-22461HIMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Queens University Medical Group CurrentSince Sep 1, 2022 Accepting new patients
The Queens Medical Center Past Accepting new patients
The Queen'S Medical Center Past Accepting new patients

Locations

91-2141 Fort Weaver Rd
Ewa Beach, HI 96706
Phone (808) 678-7000

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

Interoperability endpoints

  • Direct secure messaging: smishra61733@cityofhope.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1639663628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91-2141 FORT WEAVER RD",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967061993",
            "telephone_number": "808-691-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-2141 FORT WEAVER RD",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967061993",
            "telephone_number": "808-691-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W California Blvd",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911053010",
            "country_code": "US",
            "telephone_number": "626-421-7733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "SUBODH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-21",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "HI",
            "license": "MD-22461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ewa Beach, HI

Sources for this page

Verify at the official NPI Registry.