BRANCH MEDICAL CLINIC ANNEX WAHIAWA (NPI# 1740489590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740489590 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC ANNEX WAHIAWA |
| Practice Address |
480 Central Ave Branch Medical Clinic Annex Wahiawa Pearl Harbor HI 96860 |
| Practice Telephone | 8086535340 |
| Mailing Telephone | 8086535340 |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2017-11-17 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL HEALTH CLINIC HAWAII |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Street Address |
480 CENTRAL AVE BRANCH MEDICAL CLINIC ANNEX WAHIAWA |
| City | PEARL HARBOR |
| State | HI |
| Zip Code | 96860 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992311930 | Branch Medical Clinic Naval Shipyard Pearl Harbor | Clinic/Center | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2020-09-16 |
| 1144841842 | Sue Ellen Alden-rudin | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2020-05-04 |
| 1982244489 | Lindsey Serapion-peralta | Dental Hygienist | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2020-01-13 |
| 1609429364 | Michelle Marie Pallera Lobaton | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860 | 2019-07-22 |
| 1548720451 | Kimi Jo Nelson | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860 | 2019-03-25 |
| 1841761525 | Heather Nycole Matz | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2018-12-06 |
| 1184192494 | Edwin Ernest Stumpf II | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2018-11-05 |
| 1902380413 | Lystra Irene Braumuller | Case Manager/Care Coordinator | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2018-09-20 |
| 1942783121 | Jennifer Yadao | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2018-09-13 |
| 1750860318 | Genine Marie Gorman | Registered Nurse | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2018-08-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770075970 | April Box | Registered Nurse | Naval Health Clinic Hawii, 480 Central Avenue, Pearl Harbor, HI 96860 | 2018-06-04 |
| 1760985535 | Daniel Thomas Weinberg | General Practice | 1430 Morton St Bldg 619, Jbphh, HI 96860 | 2018-03-17 |
| 1003325366 | Justin Hesse | Military Health Care Provider | Building 17 Bishop Point, Pearl Harbor, HI 96860 | 2017-09-29 |
| 1982057816 | John Alois Kustermann | Family Medicine | 490 Central Avenue Bldg 281, Honolulu Military Entrance Processing Station, Pearl Harbor, HI 96860 | 2016-07-15 |
| 1104290519 | Carlton Jacob Maughan | Military Health Care Provider | Bldg 17 Bishops Point, Pearl Harbor, HI 96860 | 2015-11-23 |
| 1588079206 | Naval Health Clinic Hawaii | Military/U.S. Coast Guard Pharmacy | Makalapa Rd, Bldg 1407, Pearl Harbor, HI 96860 | 2014-06-23 |
| 1922349968 | Jose Israel Lopez | Military Health Care Provider | Mdsu-1 Bishop Point, Building 17, Pearl Harbor, HI 96860 | 2013-03-14 |
| 1790056620 | Lesley Brooke Dorsey | Physician Assistant | 408 Central Ave, Jbphh, HI 96860 | 2012-01-24 |
| 1184914061 | William A Talbott | Military Health Care Provider | 850 Ticonderoga St, Pearl Harbor, HI 96860 | 2011-04-13 |
| 1275860603 | Michael J. Rodriguez | Military Health Care Provider | 822 Clark St., Nssc Medical Suite 400, Pearl Harbor, HI 96860 | 2009-11-05 |
| Find all providers in zip 96860 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992311930 | Branch Medical Clinic Naval Shipyard Pearl Harbor | Clinic/Center | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2020-09-16 |
| 1457550204 | Branch Medical Clinic Kaneohe | Clinic/Center | 480 Central Ave, Attn: Bhc Kaneohe Hawaii, Pearl Harbor, HI 96860-4908 | 2007-07-12 |
| 1073712824 | Branch Medical Clinic Camp Smith Medical Annex | Clinic/Center | 480 Central Ave, Code 02, Pearl Harbor, HI 96860-4908 | 2007-07-12 |
| 1205899879 | Naval Health Clinic Hawaii | Clinic/Center | 480 Central Ave, Pearl Harbor, HI 96860-4908 | 2006-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114230109 | Tripler Army Medical Center | Clinic/Center | 91-1010 Shangrila St, Suite 100, Kapolei, HI 96707-2161 | 2010-07-19 |
| 1538365036 | Tripler Army Medical Center | Clinic/Center | Bldg 660 Mccornack Road, Dental Clinic, Schofield Barracks, HI 96857 | 2007-06-22 |
| 1750599403 | Tripler Army Medical Center | Clinic/Center | Mccornack Rd Bldg 677, Schofield Barracks, HI 96857 | 2007-05-18 |
| 1841408598 | Tripler Army Medical Center | Clinic/Center | Mccornack Rd Bldg 682, Schofield Barracks, HI 96857 | 2007-05-18 |
| 1275518805 | Spectrum Healthcare Resources | Clinic/Center | 98-340 Koauka Loop, Apt.124, Aiea, HI 96701-4443 | 2005-12-06 |
| 1992953897 | Tripler Army Medical Center | Clinic/Center | 1 Jarrett White Rd, Na Koa Dental Clinic Bldg 678, Tripler Army Medical Center, HI 96859-5001 | 2008-09-04 |
| 1275781171 | Tripler Army Medical Center | Clinic/Center | 1 Jarrett White Rd, Honolulu, HI 96859 | 2008-09-04 |
| 1750548277 | Uscg Air Station Barbers Point | Clinic/Center | 1 Coral Sea St, Kapolei, HI 96707-3693 | 2008-05-21 |
| 1760688253 | Tripler Army Medical Center | Clinic/Center | 1 Jarrett White Rd, Dental Clinic, Tripler Army Medical Center, HI 96859-5001 | 2007-06-22 |
| 1316029259 | U.S. Coast Guard Isc Honolulu | Clinic/Center | 400 Sand Island Pkwy, Health Services Division, Honolulu, HI 96819-4326 | 2006-10-19 |
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| City | PEARL HARBOR |
| Zip Code | 96860 |
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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.