Active NPI
Fred S Tanabe, M.D.
- Internal Medicine Physician
- Aiea, HI
National Provider Identifier
1669415824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD-2729
- Practice address
- 98-1079 Moanalua Road
Suite 500
Aiea, HI 96701-4794 - Phone
- (808) 488-0990
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD-2729 | HI | Primary |
Addresses
Primary practice location
98-1079 Moanalua Road
Suite 500
Aiea, HI 96701-4794
Mailing address
98-1079 Moanalua Road
Suite 500
Aiea, HI 96701-4794
Phone (808) 488-0990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03775101 | Medicaid | HI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-2729 | HI | MD | Internal Medicine Physician |
| 2729 | HI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inteleretina Professional Group LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
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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": "1352419200000",
"number": "1669415824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98-1079 MOANALUA ROAD",
"address_2": "SUITE 500",
"city": "AIEA",
"state": "HI",
"postal_code": "967014794",
"telephone_number": "808-488-0990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98-1079 MOANALUA ROAD",
"address_2": "SUITE 500",
"city": "AIEA",
"state": "HI",
"postal_code": "967014794",
"telephone_number": "808-488-0990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANABE",
"first_name": "FRED",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2012-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "HI",
"license": "MD-2729",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03775101",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aiea, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.