NPIMap

Organization Active NPI

Queen's North Hawaii Community Hospital

  • General Practice Physician
  • Kamuela, HI
National Provider Identifier
1780177493
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL
Practice address
65-1267 Kawaihae Rd
Kamuela, HI 96743-7345
Phone
(808) 881-4745
NPI assigned
Jun 8, 2018
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
Erlynn Tabac
Title
Business Services Manager
Phone
(808) 881-4626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

65-1267 Kawaihae Rd
Kamuela, HI 96743-7345

Mailing address

67-1125 Mamalahoa Hwy
Kamuela, HI 96743-8496

Other identifiers 1

IdentifierTypeStateIssuer
518607MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180713002677 HI Part A Provider - Rural Health Clinic 0143116293 Practice locations: Kamuela, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780177493. Details of each certification follow.

Rural health clinic certification: CCN 123982

Legal name
QUEENS NORTH HAWAII COMMUNITY HOSPITAL
Doing business as
PRIMARY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 13, 2018
Last certification
Dec 13, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 1987 in HI
Enrollment address
65-1267 Kawaihae Rd
Kamuela, HI 96743-7345
Related CCNs
120028

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D2025808Queen's North Hawaii Community Hospital65-1267 Kawaihae Rd, Kamuela, HI 96743Certificate of waiverJun 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Hawaii Community Hosp7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Queens North Hawaii Community Hospital Organization, Kamuela, HI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2011 100%
Darlena Chadwick Individual Corporate DirectorTrustee Jan 24, 2022
Todd L Allen Individual Corporate DirectorTrustee Jan 1, 2024
Jason C Chang Individual Corporate DirectorBoard Chair Jul 12, 2024
Stephany Vaioleti Individual Corporate OfficerPresident Dec 1, 2023
W-2 Managing Employee Dec 1, 2023
Richard M Levy Individual Corporate DirectorTrustee Jan 15, 2014
Robert R Dean Individual Corporate DirectorTrustee Jan 1, 2023
William Mitchell Individual Corporate DirectorTrustee Jan 15, 2014
Robert Hastings Individual Corporate DirectorTrustee Jan 15, 2014
Kyle J.K. Chock Individual Corporate DirectorBoard Member Jan 1, 2017
Money S Atwal Individual Corporate OfficerTreasurer Dec 2, 2016
Patrick D Ching Individual Corporate DirectorTrustee Jan 1, 2025
Shariann K Gonsalves Individual Corporate OfficerSecretary May 23, 2014

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Women's CenterKamuela, HI, CCN 123981 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 25, 2003

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1780177493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67-1125 MAMALAHOA HWY",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967438496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65-1267 KAWAIHAE RD",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967437345",
            "telephone_number": "808-881-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "TABAC",
        "authorized_official_first_name": "ERLYNN",
        "authorized_official_title_or_position": "BUSINESS SERVICES MANAGER",
        "authorized_official_telephone_number": "808-881-4626"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518607",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kamuela, HI

Sources for this page

Verify at the official NPI Registry.