Jacquelynn Dian Henderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5994 Issued in AZ

Practice address

4800 N 22ND St
Phoenix, AZ 85016-4701

Phone

(602) 955-1000

Fax

(602) 508-4830

NPI assigned

Mar 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Barnet Dulaney Perkins Eye Center, PCGroup PAC ID 0749288298, 104 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.86 of 100Reported as group

Quality

81.82

Promoting interoperability

100

Improvement activities

40

Cost

64.4

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FBDIAA

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.

• Barnet Dulaney Perkins Eye Center, PC

  • Ophthalmology Physician
  • Phoenix, AZ
  • NPI 1376574707
  Medicare reassignment Care Compare group NPD
• Barnet Dulaney Perkins Eye Center, PC

  • Ambulatory Surgical Clinic/Center
  • Mesa, AZ
  • NPI 1043910078
  NPD
• Barnet Dulaney Perkins Eye Center, PC

  • Ophthalmology Physician
  • Safford, AZ
  • NPI 1649202771
  NPD (past)
• Med-Cure Internal Medicine, PLC

  • Primary Care Clinic/Center
  • Goodyear, AZ
  • NPI 1831323708
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1003875253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N 22ND ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164701",
            "telephone_number": "602-955-1000",
            "fax_number": "602-508-4830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 N 22ND ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164701",
            "telephone_number": "602-955-1000",
            "fax_number": "602-508-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JACQUELYNN",
        "middle_name": "DIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA13970",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z181353",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leanette Henagan, DBH. LCSW, LISAC
• Fiona Henderson-Power, FNP
• Anne Henderson, MD
• Erika Shea Henderson, PA-C
• Guy Simon-Fraser Henderson, PHARMD
• Jaime Henderson, DPT
• Jeffrey Thomas Henderson, M.D.
• Jordan Henderson
• Keith Henderson
• Knicky S Henderson, RPH

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.