NPIMap

Organization Active NPI

Kaiser Foundation Health Plan, Inc.

Doing business as Kaiser Permanente Wailuku Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Wailuku, HI
National Provider Identifier
1821164476
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
HMF FSOF-10 Issued in HI
Legal business name
KAISER FOUNDATION HEALTH PLAN, INC.
Doing business as
Kaiser Permanente Wailuku Ambulatory Surgery Center
Practice address
80 Mahalani St
Wailuku, HI 96793-2531
Phone
(808) 243-6000
Fax
(808) 243-6627
NPI assigned
Nov 27, 2006
Last updated
Nov 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Authorized official

Name
James G. Adam Jr.
Title
Executive Director, Finance Leader
Phone
(808) 286-6758

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X HMF FSOF-10 HI Primary

Addresses

Primary practice location

80 Mahalani St
Wailuku, HI 96793-2531

Mailing address

711 Kapiolani Blvd
Billing Department
Honolulu, HI 96813-5214
Phone (808) 432-5312

Other names 1

  • Kaiser Permanente Wailuku Ambulatory Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040831000706 HI Part B Supplier - Ambulatory Surgical Center 1850205360 1 other NPI on this enrollment
Practice locations: Honolulu, HI; Wailuku, HI

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Kaiser Wailuku Clinic ASCCCN 12C0001100
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation Hosp Phcy379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Kaiser Permanente Central HospitalSeattle, WA, CCN 500052 Hospital 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2017
Kaiser Permenante Washington Home HealthSeattle, WA, CCN 507007 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2017
Kaiser Permanente Care at Home, Big Island Home HealthKailua Kona, HI, CCN 127317 Home health agency Operational/Managerial Control Nov 1, 2023
Kpwa Home Health & HospiceSeattle, WA, CCN 501521 Hospice 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2017
Kahuku ClinicKahuku, HI, CCN 123806 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2017
Lahaina ClinicLahaina, HI, CCN 123804 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2017
Kihei ClinicKihei, HI, CCN 123805 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2017

Owned or controlled facilities with NPI records 10

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

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1821164476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 KAPIOLANI BLVD",
            "address_2": "BILLING DEPARTMENT",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135214",
            "telephone_number": "808-432-5312",
            "fax_number": "808-432-5239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932531",
            "telephone_number": "808-243-6000",
            "fax_number": "808-243-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "ADAM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, FINANCE LEADER",
        "authorized_official_telephone_number": "808-286-6758",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "HI",
            "license": "HMF FSOF-10",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente Wailuku Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Permanente Wailuku Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.