Individual provider Active NPI

Donald W Traller, P.A.-C

  • Medical Physician Assistant
  • Lihue, HI
National Provider Identifier
1790801108
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
ADA69 Issued in HI
Practice address
3-3420 Kuhio Hwy Ste B
Lihue, HI 96766-1098
Phone
(808) 256-1380
Fax
(808) 246-1381
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X ADA69 HI Primary

Addresses

Primary practice location

3-3420 Kuhio Hwy Ste B
Lihue, HI 96766-1098

Mailing address

3639 Ilima PL
Kalaheo, HI 96741-9153
Phone (808) 332-5862

Other identifiers 1

IdentifierTypeStateIssuer
53754001MedicaidHI

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041215000772 HI Practitioner - Physician Assistant 8224095849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.39 of 100Reported as group
Quality
79.9
Promoting interoperability
99
Improvement activities
40
Cost
82.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
ADA69HIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kauai Medical Clinic CurrentSince Jan 1, 1999 Accepting new patients
Kauai Medical Clinic CurrentSince Jan 1, 1999 Accepting new patients
Kapiolani Medical Center for Women & Children Past Accepting new patients

Locations

1946 Young St
Ste 320
Honolulu, HI 96826

3-3420 Kuhio Hwy
Ste B
Lihue, HI 96766
Phone (808) 245-1500

3-3420 Kuhio Hwy
Ste B
Lihue, HI 96766
Phone (808) 245-1500

Organizations & group practices 3

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": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790801108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3639 ILIMA PL",
            "city": "KALAHEO",
            "state": "HI",
            "postal_code": "967419153",
            "telephone_number": "808-332-5862",
            "fax_number": "808-332-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3-3420 KUHIO HWY STE B",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967661098",
            "telephone_number": "808-256-1380",
            "fax_number": "808-246-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRALLER",
        "first_name": "DONALD",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "HI",
            "license": "ADA69",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53754001",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lihue, HI

Sources for this page

Verify at the official NPI Registry.