NPIMap

Organization Active NPI

Hawaiian Islands Dermatology, LLC

  • Dermatology Physician
  • Kailua, HI
National Provider Identifier
1891310355
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
HAWAIIAN ISLANDS DERMATOLOGY, LLC
Practice address
1051 Keolu Dr Ste 107
Kailua, HI 96734-3800
Phone
(808) 263-3233
Fax
(808) 263-3220
NPI assigned
Jun 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Authorized official

Name
Tami Black
Title
Office Manager
Phone
(808) 263-3233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1051 Keolu Dr Ste 107
Kailua, HI 96734-3800

Mailing address

1051 Keolu Dr Ste 107
Kailua, HI 96734-3800
Phone (808) 263-3233

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dwilliams@kailuaderm.emadirect.md Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200710001469 HI Part B Supplier - Clinic/Group Practice 0941623839 Receives reassigned benefits from 3 practitioners
Practice locations: Kailua, HI

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D2187219Hawaiian Islands Dermatology1051 Keolu Drive, Suite 107, Kailua, HI 96734Provider-performed microscopyJun 25, 2028

National Provider Directory

National Provider Directory

Locations

2330 N Alma School Rd
Ste 124
Chandler, AZ 85224
Phone (480) 755-2277

Practitioners & affiliated clinicians

Practitioners 10

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": "1591747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1891310355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 KEOLU DR STE 107",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343800",
            "telephone_number": "808-263-3233",
            "fax_number": "808-263-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 KEOLU DR STE 107",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343800",
            "telephone_number": "808-263-3233",
            "fax_number": "808-263-3220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWAIIAN ISLANDS DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "808-263-3233"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwilliams@kailuaderm.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1051 Keolu Dr Ste 107",
            "city": "Kailua",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967343800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kailua, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.