NPIMap

Organization Active NPI

Retina Institute of Hawaii LLC

  • Ophthalmology Physician
  • Kailua Kona, HI
National Provider Identifier
1801859871
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
RETINA INSTITUTE OF HAWAII LLC
Practice address
77-6403 Nalani St FL 2
Kailua Kona, HI 96740-9763
Phone
(808) 955-0255
Fax
(808) 955-4155
NPI assigned
Apr 10, 2006
Last updated
Oct 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Michael D Bennett, MDNPI 1043274111
Title
Owner Founder
Phone
(808) 955-0255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

77-6403 Nalani St FL 2
Kailua Kona, HI 96740-9763

Mailing address

PO Box 1300
Mailcode 61323
Honolulu, HI 96807-1300
Phone (808) 955-0255

Other practice location 1

1620 Ala Moana Blvd Ste 500
Honolulu, HI 96815-1437
Phone (808) 955-0255

Other identifiers 1

IdentifierTypeStateIssuer
50433301MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050805000516 HI Part B Supplier - Clinic/Group Practice 1254360647 Receives reassigned benefits from 7 practitioners
Practice locations: Waipahu, HI; Lihue, HI; Kailua Kona, HI; Honolulu, HI; Kailua, HI; Kahului, HI; Ewa Beach, HI; Hilo, HI
O20231002002117 HI DME Supplier - Physician - Ophthalmology 1254360647 Practice locations: Kailua-Kona, HI

National Provider Directory

National Provider Directory
Tax ID family
Retina Institute of Hawaii LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1801859871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1300",
            "address_2": "MAILCODE 61323",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968071300",
            "telephone_number": "808-955-0255",
            "fax_number": "808-955-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77-6403 NALANI ST FL 2",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967409763",
            "telephone_number": "808-955-0255",
            "fax_number": "808-955-4155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1620 Ala Moana Blvd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968151437",
            "country_code": "US",
            "telephone_number": "808-955-0255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RETINA INSTITUTE OF HAWAII LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER FOUNDER",
        "authorized_official_telephone_number": "808-955-0255",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50433301",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.