Individual provider Active NPI

Jason R. Egloff, M.D.

  • Family Medicine Physician
  • Wailuku, HI
National Provider Identifier
1730389933
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD-17607 Issued in HI
Practice address
55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone
(808) 243-6050
NPI assigned
Jul 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X MD-17607 HI Primary

Addresses

Primary practice location

55 Maui Lani Pkwy
Wailuku, HI 96793-2416

Mailing address

55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150120001726 HI Practitioner - Family Practice 5698828259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hawaii Permanente Medical Group IncGroup PAC ID 7618880667, 705 clinicians

Practice addresses (Care Compare)

3288 Moanalua Rd
Honolulu, HI 96819-1469
Phone (808) 432-0000

55 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 243-6050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD-17607HIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Nov 3, 2014 Accepting new patients
Emergency Medicine Specialist, Apmc Past Accepting new patients

Locations

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

55 Maui Lani Pkwy
Wailuku, HI 96793
Phone (808) 243-6000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1730389933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-243-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-243-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGLOFF",
        "first_name": "JASON",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-25",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD-17607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "55 Maui Lani Pkwy",
            "city": "Wailuku",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967932416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.