Individual provider Active NPI

Jennifer Maeda, O.D.

  • Optometrist
  • Hilo, HI
National Provider Identifier
1699853150
Registry record updated May 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
576 Issued in HI
Practice address
1234 Kilauea Ave
Hilo, HI 96720-4206
Phone
(808) 935-5228
Fax
(808) 969-9117
NPI assigned
Nov 1, 2006
Last updated
May 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 576 HI Primary

Addresses

Primary practice location

1234 Kilauea Ave
Hilo, HI 96720-4206

Mailing address

1234 Kilauea Ave
Hilo, HI 96720-4282
Phone (808) 935-5228

Other identifiers 5

IdentifierTypeStateIssuer
253237OtherHIHMSA PROVIDER NUMBER
574170-01MedicaidHI
7786656OtherHIUHA MEDICAL
778665620OtherHIUHA VISION
H100356OtherHIHAWAII MEDICARE

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
I20050503000553 HI Practitioner - Optometry 9638118300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1234 Kilauea Ave
Hilo, HI 96720-4282
Phone (808) 935-5228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
576HIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Andrew Y Maeda OD a Professional Corporation Optometrist CurrentSince Dec 1, 2004 Accepting new patients

Locations

1234 Kilauea Ave
Hilo, HI 96720
Phone (808) 935-5228

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1699853150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 KILAUEA AVE",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967204282",
            "telephone_number": "808-935-5228",
            "fax_number": "808-969-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 KILAUEA AVE",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967204206",
            "telephone_number": "808-935-5228",
            "fax_number": "808-969-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAEDA",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "HI",
            "license": "576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA PROVIDER NUMBER",
            "identifier": "253237",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "574170-01",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHA MEDICAL",
            "identifier": "7786656",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHA VISION",
            "identifier": "778665620",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAWAII MEDICARE",
            "identifier": "H100356",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hilo, HI

Sources for this page

Verify at the official NPI Registry.