Active NPI
Jenelyn P. Okumoto, DPT
- Physical Therapist
- Kapolei, HI
National Provider Identifier
1811074024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2486
- Practice address
- 1001 Kamokila Blvd
Suite 114
Kapolei, HI 96707-2014 - Phone
- (808) 674-9595
- Fax
- (808) 674-9696
- NPI assigned
- Nov 1, 2006
- Last updated
- Apr 8, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2486 | HI | Primary |
Addresses
Primary practice location
1001 Kamokila Blvd
Suite 114
Kapolei, HI 96707-2014
Mailing address
1001 Kamokila Blvd
Suite 114
Kapolei, HI 96707-2014
Phone (808) 674-9595
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56497301 | Medicaid | HI | |
| 0000251876 | Other | HI | HMSA |
Other names 1
- Jenelyn A. Peralta
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2486 | HI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Warfighter's Clinic | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pain Medicine Physician
- Kapolei, HI
- NPI 1003357765
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302220800000",
"number": "1811074024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 KAMOKILA BLVD",
"address_2": "SUITE 114",
"city": "KAPOLEI",
"state": "HI",
"postal_code": "967072014",
"telephone_number": "808-674-9595",
"fax_number": "808-674-9696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 KAMOKILA BLVD",
"address_2": "SUITE 114",
"city": "KAPOLEI",
"state": "HI",
"postal_code": "967072014",
"telephone_number": "808-674-9595",
"fax_number": "808-674-9696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKUMOTO",
"first_name": "JENELYN",
"middle_name": "P.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2011-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "2486",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "56497301",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA",
"identifier": "0000251876",
"state": "HI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENELYN",
"last_name": "PERALTA",
"middle_name": "A.",
"credential": "DPT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Kapolei, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.