NPIMap

Organization Active NPI

Amy Reisenauer MD LLC

  • Dermatology Physician
  • Kihei, HI
National Provider Identifier
1922550987
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD13436 Issued in HI
Legal business name
AMY REISENAUER MD LLC
Practice address
1300 N Holopono St Ste 215
Kihei, HI 96753-6945
Phone
(808) 874-3444
NPI assigned
Oct 25, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Amy Kersten Reisenauer, M.D.NPI 1104927110
Title
Owner
Phone
(808) 874-3444

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X MD13436 HI Primary

Addresses

Primary practice location

1300 N Holopono St Ste 215
Kihei, HI 96753-6945

Mailing address

1300 N Holopono St Ste 215
Kihei, HI 96753-6945
Phone (808) 874-3444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170711003419 HI Part B Supplier - Clinic/Group Practice 3173892809 Receives reassigned benefits from 9 practitioners
Practice locations: Kihei, 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
12D2134265Amy Reisenauer MD LLC1300 North Holopono St Suite 215, Kihei, HI 96753ComplianceNov 13, 2027

National Provider Directory

National Provider Directory

Locations

1300 N Holopono St
Ste 215
Kihei, HI 96753
Phone (800) 874-3444

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1922550987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N HOLOPONO ST STE 215",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967536945",
            "telephone_number": "808-874-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N HOLOPONO ST STE 215",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967536945",
            "telephone_number": "808-874-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY REISENAUER MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "REISENAUER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "KERSTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-874-3444",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "HI",
            "license": "MD13436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kihei, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.