NPIMap

Organization Active NPI

Pearl City Medical Associates, Inc.

  • Internal Medicine Physician
  • Aiea, HI
National Provider Identifier
1962446609
Registry record updated Nov 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PEARL CITY MEDICAL ASSOCIATES, INC.
Practice address
98-1079 Moanalua Road
Suite 500
Aiea, HI 96701-4794
Phone
(808) 488-0990
Fax
(808) 486-4696
NPI assigned
Jun 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2009

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

Authorized official

Name
Dr. Bridgit KL Rovner, M.D.NPI 1417990664
Title
President
Phone
(808) 488-1943

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

98-1079 Moanalua Road
Suite 500
Aiea, HI 96701-4794

Mailing address

98-1079 Moanalua Road
Suite 500
Aiea, HI 96701-4794
Phone (808) 488-0990

Other identifiers 1

IdentifierTypeStateIssuer
50370701MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040527000308 HI Part B Supplier - Clinic/Group Practice 1456332238 Receives reassigned benefits from 13 practitioners
Practice locations: Aiea, 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
12D0691939Pearl City Medical Associates, Inc98-1079 Moanalua Road, Suite 500, Aiea, HI 96701Provider-performed microscopyApr 26, 2027

National Provider Directory

National Provider Directory

Locations

98-1079 Moanalua Rd
Ste 500
Aiea, HI 96701
Phone (808) 488-0990

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257120000000",
    "number": "1962446609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98-1079 MOANALUA ROAD",
            "address_2": "SUITE 500",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014794",
            "telephone_number": "808-488-0990",
            "fax_number": "808-486-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-1079 MOANALUA ROAD",
            "address_2": "SUITE 500",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014794",
            "telephone_number": "808-488-0990",
            "fax_number": "808-486-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL CITY MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2009-11-02",
        "status": "A",
        "authorized_official_last_name": "ROVNER",
        "authorized_official_first_name": "BRIDGIT",
        "authorized_official_middle_name": "KL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-488-1943",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50370701",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; 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.