Jason Bumanglag Redick, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT-815-0 Issued in HI

Practice address

91-2128 Old Ft Weaver Rd
Ewa Beach, HI 96706-1911

Phone

(808) 589-1829

NPI assigned

Sep 8, 2017

Last updated

Jan 19, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dynamic Family Therapy LLC

  • Marriage & Family Therapist
  • Aiea, HI
  • NPI 1659974400
  Medicare reassignment
• Hale Kipa, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ewa Beach, HI
  • NPI 1164627246
  NPD

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1841718962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 PIIKOI ST, SUITE 203",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96814",
            "telephone_number": "808-589-1829",
            "fax_number": "808-589-2610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-2128 OLD FT WEAVER RD",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967061911",
            "telephone_number": "808-589-1829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDICK",
        "first_name": "JASON",
        "middle_name": "BUMANGLAG",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-08",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT-815-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002276625",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darwin Carlos Raquel, RN
• Blake Rausch, DC
• Lacy Christine Razor, APRN, FNP-C
• Realshift Mental Health and Wellness
• Sjophe A Reardon
• Natalie Jean Reighard, RBT
• Richard Todd Rentz, MS - PSYCH
• Gisele Rerolle, MS, ATC
• RFC Transport, LLC
• Jonathan Matthew Rhine, M.D., PHD

• Marriage & Family Therapist in Ewa Beach, HI
• Providers in Ewa Beach, HI by specialty
• Marriage & Family Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.