Active NPI
Marvin Graves Henderson, MD
- Anesthesiology Physician
- Omaha, NE
National Provider Identifier
1013025535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 16232
- Practice address
- 6901 N 72 Street
Omaha, NE 68122 - Phone
- (402) 778-9738
- Fax
- (402) 334-2849
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 24054 | IA | |
| Anesthesiology Physician | 207L00000X | 16232 | NE | Primary |
Addresses
Primary practice location
6901 N 72 Street
Omaha, NE 68122
Mailing address
PO Box 34310
Omaha, NE 68134
Phone (402) 778-9738
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47-0550438-13 | Medicaid | NE | |
| 2213876 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24054 | IA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Anesthesia PC | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Omaha, NE
- NPI 1891803300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266537600000",
"number": "1013025535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34310",
"city": "OMAHA",
"state": "NE",
"postal_code": "68134",
"telephone_number": "402-778-9738",
"fax_number": "402-334-2849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6901 N 72 STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "68122",
"telephone_number": "402-778-9738",
"fax_number": "402-334-2849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "MARVIN",
"middle_name": "GRAVES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2010-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IA",
"license": "24054",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NE",
"license": "16232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47-0550438-13",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2213876",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.