Venture Medical 21 Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

VENTURE MEDICAL 21 INC

Practice address

91-896 Makule Rd Ste 102
Ewa Beach, HI 96706-2543

Phone

(808) 689-4414

Fax

(808) 689-7115

NPI assigned

Jul 26, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Jose D Reque

Title

President

Phone

(808) 531-7878

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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

• Jacqueline Yvonne Chacon, ANP

  • Family Nurse Practitioner
  • Ewa Beach, HI
  • NPI 1023376779

  HI

  Medicare reassignment NPD
• Jose C Deleon, M.D.

  • Internal Medicine Physician
  • Honolulu, HI
  • NPI 1275639866

  HI

  Medicare reassignment NPD
• Macrina U Vicerra-Jaena, APRN

  • Family Nurse Practitioner
  • Ewa Beach, HI
  • NPI 1992758015

  HI

  Medicare reassignment NPD
• Medhat Saad Ayad, M.D.

  • Anesthesiology Physician
  • Carbondale, IL
  • NPI 1952489403
  NPD (past)

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408060800000",
    "number": "1851647952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 RICHARDS ST STE 990",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968134722",
            "telephone_number": "808-531-7878",
            "fax_number": "808-531-7829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-896 MAKULE RD STE 102",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967062543",
            "telephone_number": "808-689-4414",
            "fax_number": "808-689-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENTURE MEDICAL 21 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2014-08-15",
        "status": "A",
        "authorized_official_last_name": "REQUE",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-531-7878",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF HAWAII",
            "identifier": "W8141213401",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mina Vassey
• Vegafit Elite Fitness and Training
• Rashauna P.J.K. Vegas, MSW
• Marissa Vellichor
• Venture ABA Hawaii LLC
• Macrina U Vicerra-Jaena, APRN
• Ryan Amos Viernes
• Skylar Sterling Vieselmeyer, DC
• Hilda Vigil
• Barbara Vili-Alofa

• All providers in Ewa Beach, HI
• Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.