Amy Reisenauer MD LLC
Organization Active NPI Dermatology Physician · Kihei, HI
NPI 1922550987 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1922550987
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- MD13436 (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
- Organization subpart
- No
Authorized official
- Name
- Amy Kersten Reisenauer, M.D.
- Title
- Owner
- Phone
- (808) 874-3444
Practitioners 14
-
Amy K Reisenauer, MD
-
Nicole Matsui, PA-C
-
Alan S. W. Song, MD
-
Crystal Ai Yaple Yamada, APRN
-
Seaver Lee Soon, M.D.
-
Heidi Sarkozy, PHYSICIAN ASSISTANT
-
Ann Chang Brewer, M.D.
-
Daniel E. Zelac, M.D.
-
Marcus Juen Yue Ko, M.D.
-
Frances Astorga Bacchus, MSN, NP-C
-
Bradford William Lee, M.D., M.SC.
-
Mick Takeshi Kimura York, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 12D2134265 | Amy Reisenauer MD LLC | Compliance | Nov 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170711003419 | HI | Part B Supplier - Clinic/Group Practice | 3173892809 |
Receives reassigned benefits from 9 practitioners Practice locations: Kihei, HI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | MD13436 | HI | Yes |
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
NPI Registry JSON
{
"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": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.