NPIMap

Organization Active NPI

State of Hawaii Department of Health

  • Community/Behavioral Health Agency
  • Hauula, HI
National Provider Identifier
1679756563
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
STATE OF HAWAII DEPARTMENT OF HEALTH
Practice address
54-010 Kukuna Road
Hauula, HI 96717
Phone
(808) 233-3775
NPI assigned
Dec 13, 2007
Organization subpart
Yes
Parent organization
STATE OF HAWAII DEPARTMENT OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

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

Authorized official

Name
Raquel B. Nakahara
Title
Financial Resource Specialist
Phone
(808) 590-7320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

54-010 Kukuna Road
Hauula, HI 96717

Mailing address

1250 Punchbowl St
RM 256
Honolulu, HI 96813-2416
Phone (808) 590-7320

Other identifiers 1

IdentifierTypeStateIssuer
53937214MedicaidHI

Other names 1

  • Koolauloa Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040127000902 HI Part B Supplier - Clinic/Group Practice 5395648539 Receives reassigned benefits from 23 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kealakekua, HI; Lahaina, HI; Lanai City, HI; Kaneohe, HI; Lihue, HI; Naalehu, HI; Pahoa, HI; Pearl City, HI…

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Part of
Hawaii County Comm HLTH

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1679756563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PUNCHBOWL ST",
            "address_2": "RM 256",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132416",
            "telephone_number": "808-590-7320",
            "fax_number": "808-586-4745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54-010 KUKUNA ROAD",
            "city": "HAUULA",
            "state": "HI",
            "postal_code": "96717",
            "telephone_number": "808-233-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF HAWAII DEPARTMENT OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF HAWAII DEPARTMENT OF HEALTH",
        "enumeration_date": "2007-12-13",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "NAKAHARA",
        "authorized_official_first_name": "RAQUEL",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "FINANCIAL RESOURCE SPECIALIST",
        "authorized_official_telephone_number": "808-590-7320"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53937214",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koolauloa Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hauula, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.