NPIMap

Organization Active NPI

Main Street Pediatrics LLC

  • Primary Care Clinic/Center
  • Kamuela, HI
National Provider Identifier
1821771353
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MAIN STREET PEDIATRICS LLC
Practice address
64-1061 Mamalahoa Hwy Apt 203
Kamuela, HI 96743-8480
Phone
(808) 333-5855
Fax
(808) 333-5855
NPI assigned
Aug 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Authorized official

Name
Jana MullenNPI 1043291115
Title
Owner
Phone
(505) 690-3562

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

64-1061 Mamalahoa Hwy Apt 203
Kamuela, HI 96743-8480

Mailing address

PO Box 485
Paauilo, HI 96776-0485

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JFCADA

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1821771353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 485",
            "city": "PAAUILO",
            "state": "HI",
            "postal_code": "967760485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64-1061 MAMALAHOA HWY APT 203",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967438480",
            "telephone_number": "808-333-5855",
            "fax_number": "808-333-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-690-3562"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kamuela, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.