NPIMap

Organization Active NPI

Waikiki Health

  • Federally Qualified Health Center (FQHC)
  • Honolulu, HI
National Provider Identifier
1679646509
Registry record updated Dec 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAIKIKI HEALTH
Practice address
277 Ohua Avenue
Honolulu, HI 96815-3643
Phone
(808) 922-4787
Fax
(808) 922-6454
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2013

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

Authorized official

Name
Sheila Beckham, RD, MPH
Title
Chief Executive Officer
Phone
(808) 791-9302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

277 Ohua Avenue
Honolulu, HI 96815-3643

Mailing address

277 Ohua Avenue
Honolulu, HI 96815-3643
Phone (808) 922-4787

Other identifiers 1

IdentifierTypeStateIssuer
04701301MedicaidHI

Other names 1

  • Waikiki Health Ohua Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040419000226 HI Part A Provider - Federally Qualified Health Center (FQHC) 9335058536 Practice locations: Honolulu, HI
O20040521000013 HI Part B Supplier - Clinic/Group Practice 9335058536 Receives reassigned benefits from 49 practitioners
7 other NPIs on this enrollment
Practice locations: Honolulu, HI

Federally qualified health center certification: CCN 121814

Legal name
WAIKIKI HEALTH
Doing business as
WAIKIKI HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 3, 2002
Last certification
Oct 3, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 1967 in HI
Enrollment address
277 Ohua Avenue
Honolulu, HI 96815-6612

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

1903 Palolo Ave
Honolulu, HI 96816
Phone (808) 922-4787

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Todd Okamoto Individual Corporate OfficerChief Financial Officer Jan 1, 2015 100%
Phyllis Dendle Individual Corporate OfficerChief Executive Officer Nov 30, 2018 100%
Elliot J Kalauawa Individual Corporate OfficerChief Medical Officer Sep 19, 2011
W-2 Managing Employee Sep 19, 2011
James T Maruyama Individual W-2 Managing EmployeeCompliance Officer Dec 1, 2017

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Waikiki HealthHonolulu, HI, CCN 121850 Federally qualified health center Operational/Managerial Control (100%) Jul 10, 2013

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 82

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

View all 82

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386288000000",
    "number": "1679646509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 OHUA AVENUE",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968153643",
            "telephone_number": "808-922-4787",
            "fax_number": "808-922-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 OHUA AVENUE",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968153643",
            "telephone_number": "808-922-4787",
            "fax_number": "808-922-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAIKIKI HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2013-12-06",
        "status": "A",
        "authorized_official_last_name": "BECKHAM",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "808-791-9302",
        "authorized_official_credential": "RD, MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04701301",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waikiki Health Ohua Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.