Hawaii Dermatopathology LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

12D2120536 Issued in HI

Legal business name

HAWAII DERMATOPATHOLOGY LLC

Practice address

1300 N Holopono St Ste 214
Kihei, HI 96753-6945

Phone

(808) 874-3444

NPI assigned

Jan 13, 2017

Organization subpart

No

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

Authorized official

Name

Amy Kersten Reisenauer, MDNPI 1104927110

Title

Lab Director/Owner

Phone

(808) 264-2293

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Amy K Reisenauer, MD

  • Dermatopathology Physician
  • Kihei, HI
  • NPI 1104927110
  Medicare reassignment NPD Authorized official
• Timothy Hugh McCalmont, M.D.

  • Dermatopathology (Pathology) Physician
  • Walnut Creek, CA
  • NPI 1275598732
  NPD

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780120709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N HOLOPONO ST STE 214",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967536945",
            "telephone_number": "808-874-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N HOLOPONO ST STE 214",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967536945",
            "telephone_number": "808-874-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWAII DERMATOPATHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "REISENAUER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "KERSTEN",
        "authorized_official_title_or_position": "LAB DIRECTOR/OWNER",
        "authorized_official_telephone_number": "808-264-2293",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "HI",
            "license": "12D2120536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "12D2120536",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lara Harvey
• Brandi Hashimoto, RBT
• Loma Harrison Hassell II, M.D.
• Mary Alexis Hatfield, LMT
• Hawaii Dental Group, Inc.
• Brooke Hayes, PA-C
• Candice Hayes, D.C.
• Hearing AIDS of Hawaii
• Michelle Hebert, LMT
• Heike Kholooci, PSYD LLC

• Clinical Medical Laboratory in Kihei, HI
• Providers in Kihei, HI by specialty
• Clinical Medical Laboratory in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.