Ayesha Wilbourn, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD-23573 Issued in HI

Practice address

400 Keawe St
Honolulu, HI 96813-5199

Phone

(808) 735-0007

NPI assigned

May 13, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ayesha Safo Former name

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Queens Medical Center Hospital, Honolulu, HI, CCN 120001

Merit-based Incentive Payment System (MIPS)

Final score

97.05 of 100Reported as apm

Quality

89.81

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Queens University Medical Group

  • Multi-Specialty Clinic/Center
  • Honolulu, HI
  • NPI 1891441382
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Queens Medical Center

  • General Acute Care Hospital
  • Honolulu, HI
  • NPI 1184612764
  Care Compare affiliation

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

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1962858415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 KEAWE ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135199",
            "telephone_number": "808-735-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 KEAWE ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135199",
            "telephone_number": "808-735-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBOURN",
        "first_name": "AYESHA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-13",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD-23573",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "217603",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AYESHA",
            "last_name": "SAFO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrea Wieland, APRN - RX, FNP -C
• Robin Wielins, AUD
• John Clay Wiggins
• Emma Lee Wigren
• Wihc, LLC
• Jimmie Wilbourn
• Samantha Wilcox-Zimmer
• Janae Wilcoxon
• Nadirah Wilds
• Wilfred a. Miyasaki, D.M.D., Inc.

• Family Medicine Physician in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Family Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.