NPIMap

Organization Active NPI

Island Cardiovascular & Vein Institute LLC

  • Interventional Cardiology Physician
  • Kailua Kona, HI
National Provider Identifier
1881362739
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
ISLAND CARDIOVASCULAR & VEIN INSTITUTE LLC
Practice address
75-5591 Palani Rd Ste 2002
Kailua Kona, HI 96740-3634
Phone
(210) 218-3328
NPI assigned
Sep 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Authorized official

Name
Dr. Jamison Wyatt, MDNPI 1568642361
Title
President Physician
Phone
(210) 218-3328

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
Interventional Cardiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0011X Primary

Addresses

Primary practice location

75-5591 Palani Rd Ste 2002
Kailua Kona, HI 96740-3634

Mailing address

75-5591 Palani Rd Ste 2002
Kailua Kona, HI 96740-3634
Phone (210) 218-3328

Other identifiers 1

IdentifierTypeStateIssuer
MD-20303OtherHIHAWAII MEDICAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210922002673 HI Part B Supplier - Clinic/Group Practice 0547667222 Receives reassigned benefits from 6 practitioners
Practice locations: Hilo, HI; Kailua Kona, HI

National Provider Directory

National Provider Directory

Locations

75-5591 Palani Rd
Ste 3001
Kailua Kona, HI 96740

94-673 Kupuohi St
Ste C201
Waipahu, HI 96797
Phone (808) 387-8466

Practitioners & affiliated clinicians

Practitioners 11

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": "1630627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1881362739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5591 PALANI RD STE 2002",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967403634",
            "telephone_number": "210-218-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5591 PALANI RD STE 2002",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967403634",
            "telephone_number": "210-218-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND CARDIOVASCULAR & VEIN INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-03",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "JAMISON",
        "authorized_official_title_or_position": "PRESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "210-218-3328",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAWAII MEDICAL LICENSE",
            "identifier": "MD-20303",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.