Hawaiian Islands Dermatology, LLC

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

Last updated

Jun 10, 2020By the provider in NPPES

Organization subpart

No

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

Addresses

Electronic endpoints 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

Interoperability endpoints

• Direct secure messaging: dwilliams@kailuaderm.emadirect.md

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Anthony Pasquale, D.O.

  • Plastic and Reconstructive Surgery Physician
  • Honolulu, HI
  • NPI 1639231244

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Doug Marlis Williams, PA

  • Medical Physician Assistant
  • Kailua, HI
  • NPI 1033384011
  Medicare reassignment Care Compare group
• Leslie Nichole Womack-Young, FNP-C

  • Nurse Practitioner
  • Watertown, NY
  • NPI 1851090146

  HI

  Medicare reassignment NPD
• Rebecca Bernadine Luria, MD

  • Dermatology Physician
  • Kailua, HI
  • NPI 1639155922
  NPD (past)
• Bishr Al Dabagh, MD

  • MOHS-Micrographic Surgery Physician
  • Mooresville, NC
  • NPI 1154565661

  Dermatology

  NPD (past)
• William John Cirksena Sr., M. D.

  • Nephrology Physician
  • Annapolis, MD
  • NPI 1700904000
  NPD (past)
• Tony Shuo-Wen Clinton-Merrell, MD

  • Dermatology Physician
  • Clackamas, OR
  • NPI 1982675690
  NPD (past)
• Hayes Bordman Gladstone, MD

  • Dermatology Physician
  • Danville, CA
  • NPI 1619003282
  NPD (past)
• Julie Renee Kenner, M.D., PH.D

  • Dermatology Physician
  • Monterey, CA
  • NPI 1366454423
  NPD (past)
• Helen Petros, NP, PA-C

  • Nurse Practitioner
  • Springfield, MA
  • NPI 1689671505
  NPD (past)

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": []
}

• Hawaii Physicians & Surgeons Association LLC
• Hawaii Pulmonary Health Center, LLC
• Hawaii Voice and Speech Studio LLC
• Hawaii Youth Correctional Facility
• Hawaii's Impac, LLC
• Tai Hawkins, LMT
• Monica Haynes
• Huan He
• Health Coordinators Associates
• Health in Harmony

• Dermatology Physician in Kailua, HI
• Providers in Kailua, HI by specialty
• Dermatology Physician in Hawaii

• 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.