PUKALANI FAMILY PRACTICE, LLC
NPI 1063009207
Clinic/Center - Primary Care in Makawao, HI
About Pukalani Family Practice, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PUKALANI FAMILY PRACTICE, LLC (NPI 1063009207) is a healthcare organization registered as a primary care in Makawao, Hawaii and active in the NPI registry since December 2020. The organization holds a CLIA Waiver certificate valid through December 26, 2027 and lists Dayaji Green, Office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pukalani Family Practice, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Pukalani Family Practice, LLC, which bills Medicare for the services they deliver. Of these, 6 practice at this address. They are listed nearest first.
Clinicians, nearest first (7)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 12D0724063
Pukalani Family Practice, LLC · Makawao, HIFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Pukalani Family Practice, LLC's NPI number?
The NPI number for Pukalani Family Practice, LLC is 1063009207. It was assigned to this organization in the NPPES registry on December 22, 2020.
Where is Pukalani Family Practice, LLC located?
Pukalani Family Practice, LLC is located at 81 Makawao Ave Ste 100, Makawao, HI 96768. The listed phone number is (808) 573-8900.
What is Pukalani Family Practice, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Pukalani Family Practice, LLC enrolled in Medicare?
Yes. Pukalani Family Practice, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Pukalani Family Practice, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 3 Medicare specialties reassign their Medicare billing to Pukalani Family Practice, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (5), Chiropractic (1) and Family Practice (1). Of these, 6 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Pukalani Family Practice, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 12D0724063) is associated with this NPI, valid through December 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Pukalani Family Practice, LLC accept?
Health plans from HMSA list Pukalani Family Practice, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Pukalani Family Practice, LLC was last updated on December 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Pukalani Family Practice, Llc · NPI 1063009207
Primary Care organization in Makawao, Hawaii. Organization record, active in the CMS NPPES registry since December 22, 2020.
## Identity
- **NPI:** 1063009207 (Entity type: Organization)
- **Enumerated:** December 22, 2020
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Dayaji Green, OFFICE MANAGER
## Practice location
- **Address:** 81 MAKAWAO AVE STE 100, Makawao, HI 96768-8859
- **Phone:** (808) 573-8900 · **Fax:** (808) 573-7505
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (5), Chiropractic (1), Family Practice (1); 6 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 22, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063009207) · Data from the CMS NPPES public registry.