1. Home
  2. Directory
  3. Hawaii
  4. Honolulu
  5. Clinic Center
  6. NPI Profile

HONOLULU SPORTS & SPINE SURGERY CENTER
NPI 1093830325
Clinic/Center - Ambulatory Surgical in Honolulu, HI

Active since March 19, 2007CLIA 12D1072255 · Waiver
500 ALA MOANA BLVD STE 301, HONOLULU, HI 96813(808) 237-2970 Get Directions Write a Review

NPPES record last updated: March 10, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Honolulu Sports & Spine Surgery Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HONOLULU SPORTS & SPINE SURGERY CENTER (NPI 1093830325) is a healthcare organization registered as an ambulatory surgical in Honolulu, Hawaii and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through August 9, 2027 and lists Jennifer Boyd Baldock, Officer And Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1093830325
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameHONOLULU SPINE CENTER, LLC
Location Address500 ALA MOANA BLVD STE 301Honolulu, HI 96813-4920
Mailing Address500 Ala Moana Blvd Ste 301Honolulu, HI 96813-4920 · (808) 237-2970
Phone(808) 237-2970
Organization SubpartNo
Authorized OfficialJennifer Boyd BaldockOfficer And Authorized Official · (615) 234-5900
Enumeration DateMarch 19, 2007
Last NPPES UpdateMarch 10, 2020
NPPES CertifiedMarch 10, 2020
✔ NPI 1093830325 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
500 ALA MOANA BLVD STE 301, Honolulu, HI 96813
Open in Google Maps ↗

Other Names 1

Doing Business AsHonolulu Sports & Spine Surgery Center

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HMSA.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)

Honolulu Sports & Spine Surgery Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Honolulu Sports & Spine Surgery Center, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Tristan Fried, MD
Orthopedic Surgery
NPI 1760047096
500 ALA MOANA BLVD STE 4-470
Honolulu, HI 96813
(808) 909-9115
✔ PECOS✔ Accepts Medicare0.1 mi
Christopher Lee
Certified Registered Nurse Anesthetist (CRNA)
NPI 1417570185
3288 MOANALUA RD
Honolulu, HI 96819
(808) 432-0000
✔ Accepts Medicare4.8 mi
Vincent Icalia
Certified Registered Nurse Anesthetist (CRNA)
NPI 1447846316
9127 W RUSSELL RD STE 110
Las Vegas, NV 89148
(702) 878-0070
✔ Accepts Medicare2,752 mi
Ewa Korzeniowska, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1336514728
500 W 4TH ST
Odessa, TX 79761
(432) 640-3462
✔ Accepts Medicare3,475 mi
Jenna Moliga, MSN
Certified Registered Nurse Anesthetist (CRNA)
NPI 1952832420
200 HAWKINS DR
Iowa City, IA 52242
(319) 356-1616
✔ PECOS✔ Accepts Medicare4,054 mi
Ju Lee, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1740710953
800 WASHINGTON ST
Boston, MA 02111
(617) 636-5000
✔ PECOS5,090 mi

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 12D1072255

Honolulu Spine Center LLC · Honolulu, HI
Active · expires Aug 9, 2027
CLIA Number12D1072255
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateAugust 10, 2025
Certificate Expiration DateAugust 9, 2027
Laboratory DirectorDr. Jeffrey Roh
Laboratory Phone(808) 237-2970
Laboratory LocationHonolulu Spine Center LLC500 Ala Moana Blvd Bldg 1 Ste 301, Honolulu, HI 96813
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level 64483
This procedure involves injecting a mix of numbing and anti-inflammatory medication into a specific nerve root in the lower back. It helps manage pain and reduce inflammation. The process is guided by imaging technology for precision.
47 services32 patients
Injection of substance into lower spine canal using imaging guidance 62323
This procedure involves injecting a substance into your lower spine canal, guided by real-time images. It's done to diagnose or treat various conditions. You may feel slight discomfort, but it's generally safe and can provide valuable information for your treatment plan.
29 services22 patients
Replacement of knee joint, both sides of knee 27447
A bilateral knee joint replacement is a procedure where the damaged parts of both your knee joints are replaced with artificial parts. It aims to relieve pain and improve mobility. The process involves a surgical operation under anesthesia.
28 services28 patients
Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint 64635
This procedure involves using imaging guidance to accurately target and destroy nerves in the lower or sacral spinal facet joint. It's done to relieve chronic back pain. The process is safe and usually effective.
23 services13 patients
Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment 63047
This procedure involves removing part of a spine bone to alleviate pressure on the lower spinal cord and/or nerves. It targets a single segment of the spine, improving mobility and reducing pain. It's a common treatment for conditions like herniated discs or spinal stenosis.
18 services17 patients
Partial removal of collar bone at shoulder using an endoscope 29824
This procedure involves the partial removal of the collar bone at the shoulder using an endoscope, a tool with a light and camera. It's done to relieve pain or improve shoulder movement. The surgeon makes small incisions, then uses the endoscope to guide their work.
13 services13 patients

Frequently 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 Honolulu Spine Center, LLC's NPI number?

The NPI number for Honolulu Spine Center, LLC is 1093830325. It was assigned to this organization in the NPPES registry on March 19, 2007. The provider is doing business as Honolulu Sports & Spine Surgery Center.

Where is Honolulu Spine Center, LLC located?

Honolulu Spine Center, LLC is located at 500 Ala Moana Blvd Ste 301, Honolulu, HI 96813. The listed phone number is (808) 237-2970.

What is Honolulu Spine Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Honolulu Spine Center, LLC enrolled in Medicare?

Yes. Honolulu Spine Center, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Honolulu Spine Center, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Honolulu Spine Center, 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 Certified Registered Nurse Anesthetist (CRNA) (5) and Orthopedic Surgery (1). Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Honolulu Spine Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 12D1072255) is associated with this NPI, valid through August 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Honolulu Spine Center, LLC accept?

Health plans from HMSA list Honolulu Spine Center, 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 Honolulu Spine Center, LLC was last updated on March 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.