NPIMap

Organization Active NPI

Kaiser Foundation Health Plan, Inc

  • Home Health Agency
  • Wailuku, HI
National Provider Identifier
1962552091
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
KAISER FOUNDATION HEALTH PLAN, INC
Practice address
80 Mahalani St
Wailuku, HI 96793-2531
Phone
(808) 243-6681
Fax
(808) 243-6689
NPI assigned
Jan 11, 2007
Last updated
Dec 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Authorized official

Name
Daniel N. Shaw
Title
Chief Financial Officer
Phone
(808) 432-5272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

80 Mahalani St
Wailuku, HI 96793-2531

Mailing address

711 Kapiolani Blvd
Honolulu, HI 96813-5237

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090605000468 HI Part A Provider - Home Health Agency 1850205360 Practice locations: Wailuku, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962552091. Details of each certification follow.

Home health agency certification: CCN 127023

Legal name
KAISER FOUNDATION HEALTH PLAN INC
Doing business as
KAISER PERMANENTE HOME HEALTH AGENCY MAU
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 11, 1993
Last certification
Mar 15, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 1955 in CA
Enrollment address
80 Mahalani St
FL 2
Wailuku, HI 96793-2531

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Kaiser Permanente Home Health Agency MauiCCN 127023 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Oct 11, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation Hosp Phcy379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David J Barger Individual Corporate DirectorBoard Member Nov 11, 2019
Margaret E Porfido Individual Corporate DirectorBoard Member Nov 1, 2011 100%
Jenny Ming Individual Corporate DirectorBoard Member Jul 6, 2021
Richard P Shannon Individual Corporate DirectorBoard Member Jul 1, 2014 100%
Regina M Benjamin Individual Corporate DirectorBoard Member Jun 1, 2015 100%
Michelle J Gaskill-Hames Individual Corporate OfficerRegional President Sep 18, 2023
Judith a Johansen Individual Corporate DirectorBoard Member Apr 1, 2006 100%
Pamela D Hope Individual Contracted Managing EmployeeMedical Director Nov 1, 2009 100%
Corporate Director Nov 1, 2009
Douglas a Lemieux Individual W-2 Managing EmployeeSr Director Jul 8, 2018
David F Hoffmeister Individual Corporate DirectorBoard Member Nov 1, 2014 100%
Kaiser Foundation Hospitals Organization, Oakland, CA Corporation, Non-profit Operational/Managerial Control Jan 1, 1966
Arnold Eugene Washington Individual Corporate DirectorBoard Member Jan 4, 2016 100%
Ines Gaeta Individual Operational/Managerial ControlController & Executive Director Apr 4, 2022
James Adams Individual Corporate OfficerExec Dir Finance, Hawaii Market Sep 19, 2022
W-2 Managing EmployeeExec Dir Finance, Hawaii Market Sep 19, 2022
Jeffrey E Epstein Individual Corporate DirectorBoard Member Apr 1, 2013 100%
Ramon F Baez Individual Corporate DirectorBoard Member Jun 4, 2016 100%
Gregory a Adams Individual Corporate OfficerChairman and Ceo Nov 11, 2019
Corporate DirectorChairman and Ceo Nov 11, 2019
Matthew T Ryan Individual Corporate DirectorBoard Member Jan 1, 2020
Leslie S Heisz Individual Corporate DirectorBoard Member Jan 1, 2015 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kaiser Permanente Central HospitalSeattle, WA, CCN 500052 Hospital 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2017
Kaiser Permenante Washington Home HealthSeattle, WA, CCN 507007 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2017
Kaiser Permanente Care at Home, Big Island Home HealthKailua Kona, HI, CCN 127317 Home health agency Operational/Managerial Control Nov 1, 2023
Kpwa Home Health & HospiceSeattle, WA, CCN 501521 Hospice 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2017
Kahuku ClinicKahuku, HI, CCN 123806 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2017
Lahaina ClinicLahaina, HI, CCN 123804 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2017
Kihei ClinicKihei, HI, CCN 123805 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2017

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 78

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 78

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513036800000",
    "number": "1962552091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 KAPIOLANI BLVD",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932531",
            "telephone_number": "808-243-6681",
            "fax_number": "808-243-6689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2017-12-12",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "808-432-5272"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.