PEDIATRIC MEDICAL GROUP, LLC (NPI# 1457446585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457446585 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC MEDICAL GROUP, LLC |
| Practice Address |
1712 Liliha Street Suite304 Honolulu HI 96817-3114 |
| Practice Telephone | 8085221313 |
| Practice Fax Number | 8085221309 |
| Mailing Telephone | 8085221313 |
| Mailing Fax Number | 8085221309 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. AMELIA REYES JACANG (PEDIATRICIAN) |
| Authorized Official Telephone | 8085221313 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | 1854 | HI | Managed Care Organizations |
| Street Address |
1712 LILIHA STREET SUITE304 |
| City | HONOLULU |
| State | HI |
| Zip Code | 96817-3114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114011772 | Mary Frances Ritchey | Optometrist | 1712 Liliha Street, Suite 400, Honolulu, HI 96817 | 2006-10-03 |
| 1891119723 | Jose M. Madamba, Md., Inc. | Surgery | 1712 Liliha Street, Suite 203, Honolulu, HI 96817 | 2014-02-12 |
| 1912234196 | Gloria M Madamba Md Inc | Internal Medicine | 1712 Liliha Street, Suite 203 Liliha Medical Blg., Honolulu, HI 96817 | 2009-11-10 |
| 1649337981 | Gloria M Madamba | Internal Medicine | 1712 Liliha Street, Liliha Medical Blg Suite 203, Honolulu, HI 96817 | 2007-01-03 |
| 1811085384 | Romeo Payumo Pineda Sr. | Radiology | 1712 Liliha Street, #205, Honolulu, HI 96817 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942810676 | Tracey Lorraine Ramelb Mayola | Nurse's Aide | 36 Bates St., Unit A1, Honolulu, HI 96817 | 2020-08-06 |
| 1710503032 | Ray & Cee Inc | Counselor | Heavenly Counsel, 985 Dillingham Blvd Suite 100, Honolulu, HI 96817 | 2020-06-23 |
| 1982238093 | Healthy Mothers Healthy Babies Coalition of Hawaii | Public Health or Welfare | 245 N Kukui St #102a, Kukui Center, Honolulu, HI 96817 | 2020-02-27 |
| 1770042160 | Garza Wellness Care Center, LLC | Chiropractor | 1744 Liliha St. Suite #201, Honolulu, HI 96817 | 2019-03-15 |
| 1932688165 | Behavior Analysis and Family Therapy Center of Hawaii | Marriage & Family Therapist | 200 North Vineyard Blvd, Suite B 270, Honolulu, HI 96817 | 2018-08-08 |
| 1013409382 | Marleina Dee Capua | Behavior Technician | 200 N Vineyard Blvd # A600, Honolulu, HI 96817 | 2018-06-03 |
| 1811496623 | Kimberly Jee Ying Wun | Nurse Practitioner | 860 Iwilei Road, Honolulu, HI 96817 | 2018-02-07 |
| 1144737925 | Cancer Center of Hawaii, LLC | Radiology | 2226 Liliha St, #b2, Honolulu, HI 96817 | 2018-01-03 |
| 1700315355 | Thomas Bishop | Behavioral Analyst | 200 N. Vineyard Blvd. Suite #153, Honolulu, HI 96817 | 2017-06-07 |
| 1760843890 | Kanna Dokgo | Nurse Practitioner | 321 Kuakini St., Honolulu, HI 96817 | 2016-03-17 |
| Find all providers in zip 96817 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649722547 | Dental Technology Center of Hawaii LLC | Preferred Provider Organization | 1314 S King St Ste 724, Honolulu, HI 96814-1942 | 2016-10-26 |
| 1265771828 | Donald E Nicol Md Inc | Preferred Provider Organization | 549 Halemaumau St Ste F, Honolulu, HI 96821-2150 | 2013-02-01 |
| 1255769303 | Chang Dich Lai M.d. Inc | Preferred Provider Organization | 1380 Lusitana St, Suite 1015, Honolulu, HI 96813-2449 | 2013-10-29 |
| 1649569229 | Stephen S. Gee,md, Inc. | Preferred Provider Organization | 1210 Ward Ave, Honolulu, HI 96814-1422 | 2011-04-04 |
| 1457587735 | Steven K. Sue, D.d.s., M.s., Inc. | Preferred Provider Organization | 2065 S King St Ste 304, Honolulu, HI 96826-2225 | 2009-06-01 |
| 1003066952 | Riichiro Sato, D.m.d., Ph.d. | Preferred Provider Organization | 1441 Kapiolani Blvd, Suite 722, Honolulu, HI 96814-4402 | 2008-09-29 |
| 1134346299 | Cecil Riter Dds. Inc | Preferred Provider Organization | 1441 Kapiolani Blvd, Ste#905, Honolulu, HI 96814-4402 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821409236 | Facial808 | Preferred Provider Organization | 73-4520 Hawaii Belt Road, Kailua-kona, HI 96740 | 2014-05-20 |
| 1285865170 | Sweet Tooth Dental Inc. | Preferred Provider Organization | 75-5660 Kopiko St Ste B2, Kailua Kona, HI 96740-3121 | 2009-07-27 |
| 1720029606 | Puna Kamalii Flowers, Inc. | Preferred Provider Organization | 16-211 Kalara St, Keaau, HI 96749-8005 | 2006-06-09 |
| 1326277500 | Gaerlan-tokunaga, Dds, Inc | Preferred Provider Organization | 94-307 Farrington Hwy Ste A10, Waipahu, HI 96797-2500 | 2009-07-08 |
| 1912928367 | Hawaii Vision Clinic Inc | Preferred Provider Organization | 99-128 Aiea Heights Dr, Ste 703, Aiea, HI 96701-3978 | 2006-07-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.