Individual provider Active NPI

Maureen Tanumihardja, APRN

  • Family Nurse Practitioner
  • Honolulu, HI
National Provider Identifier
1992988851
Registry record updated Aug 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN-3174 Issued in HI
Practice address
550 S Beretania St Ste 601
Honolulu, HI 96813-2423
Phone
(808) 691-8877
Fax
(808) 691-8875
NPI assigned
Dec 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP30007568 WA
Family Nurse Practitioner 363LF0000X APRN-3174 HI Primary

Addresses

Primary practice location

550 S Beretania St Ste 601
Honolulu, HI 96813-2423

Mailing address

550 S Beretania St Ste 601
Honolulu, HI 96813-2423
Phone (808) 691-8877

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210519002491 HI Practitioner - Nurse Practitioner 3678708658 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
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)

1380 Lusitana St
Honolulu, HI 96813-2448

Hospital & facility affiliations

  • Bristol Hospice - Hawaii, LLC Hospice, Honolulu, HI, CCN 121508

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP30007568WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Queen'S Medical Center Current Accepting new patients
Queens University Medical Group CurrentSince Apr 22, 2022 Accepting new patients
The Queens Medical Center CurrentSince Jul 12, 2021 Accepting new patients
The Queen'S Medical Center CurrentSince Jul 12, 2021 Accepting new patients

Locations

550 S Beretania St
Ste 404
Honolulu, HI 96813
Phone (808) 691-8897

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

550 S Beretania St
Ste 601
Honolulu, HI 96813
Phone (808) 691-8877

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

Interoperability endpoints

  • Direct secure messaging: mtanumihardja193908@ghc.direct-ci.net

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1992988851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S BERETANIA ST STE 601",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132423",
            "telephone_number": "808-691-8877",
            "fax_number": "808-691-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S BERETANIA ST STE 601",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132423",
            "telephone_number": "808-691-8877",
            "fax_number": "808-691-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANUMIHARDJA",
        "first_name": "MAUREEN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-13",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30007568",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "HI",
            "license": "APRN-3174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.