Scott K Ross, MD
Individual provider Active NPI Family Medicine Physician · Koloa, HI
NPI 1720055023 · NPPES record last updated Jun 24, 2026
Key facts
- NPI
- 1720055023
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD61382215 (WA)
- Practice address
- 2829 Ala Kalanikaumaka St.
Ste. B201
Koloa, HI 96756 - Phone
- (808) 742-0990
- NPI assigned
- Mar 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Baylor College of Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Samuel Mahelona Memorial Hospital
Practice addresses (Care Compare)
2829 Ala Kalani Kaumaka St
Koloa, HI 96756-7549
Phone (808) 742-0999
Hospital & facility affiliations
- Samuel Mahelona Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TX, WV, HI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101229001097 | TX | Practitioner - Family Practice | 8224226634 | Reassigns benefits to 2 organizations |
| I20231113000482 | WV | Practitioner - Family Practice | 8224226634 | |
| I20251208002954 | HI | Practitioner - Family Practice | 8224226634 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H2739 | TX | MD | Family Medicine Physician |
| MD61382215 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shannon Clinic | Family Medicine | Current |
Accepting new patients |
| Shannon Clinic | Family Medicine | Current |
Accepting new patients |
| Samuel Mahelona Memorial Hospital | Current | Accepting new patients | |
| Samuel Mahelona Memorial Hospital | Current |
Accepting new patients | |
| Samuel Mahelona Memorial Hospital | Current |
Accepting new patients | |
| Ozark Tri-County Health Care Consortium | Past | Accepting new patients |
Locations
2829 Ala Kalanikaumaka
Ste B201
Koloa, HI 96756
Phone (808) 742-0999
4251 Sunset Dr
San Angelo, TX 76904
Phone (325) 481-2226
120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511
3502 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 747-2222
Interoperability endpoints
- scott.ross.1@27404.direct.athenahealth.com
- sross8015@shannonhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD61382215 | WA | Yes |
| Family Medicine Physician | 207Q00000X | H2739 | TX |
Addresses
Primary practice location
2829 Ala Kalanikaumaka St.
Ste. B201
Koloa, HI 96756
Mailing address
P.O. Box 337
Waimea, HI 96796
Phone (808) 338-9431
Other practice location 1
83 Retail Commons Pkwy
Martinsburg, WV 25403-6172
Phone (304) 264-9730
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H2739 | Other | TX | LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicoxy.et0764.epichosted.com/FHIRProxy/api/FHIR/Rpr4/ |
Other providers in Koloa, HI
- Nerveflow
- Jeanette Nguyen
- Holly Marie Poag
- Poipu MD, LLC
- Puuwai Professional Enterprises, LLC
- Samuel Mahelona Memorial Hospital
- Jordan Sleeth
- Margaret Bubon Smith
- Soul Spot Non-Profit Inc
- Thrive Pediatric Therapy LLC
All providers in Koloa, HI · Family Medicine Physician in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.