NPIMap

Individual provider Active NPI

Jordan Andrew Henderson, D.O.

  • Hematology & Oncology Physician
  • Myrtle Beach, SC
National Provider Identifier
1013200328
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
39910 Issued in SC
Practice address
8121 Rourk St
Myrtle Beach, SC 29572
Phone
(843) 692-5000
Fax
(843) 692-5010
NPI assigned
May 18, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5101019226 MI
Hematology & Oncology Physician 207RH0003X 39910 SC Primary

Addresses

Primary practice location

8121 Rourk St
Myrtle Beach, SC 29572

Mailing address

8121 Rourk St
Myrtle Beach, SC 29572-4128
Phone (843) 692-5000

Other practice location 1

4620 Highway 17
Murrells Inlet, SC 29576-5016
Phone (843) 357-7357

Other practice location 2

3008 Bayboro St
Loris, SC 29569-2714
Phone (843) 756-0932

Other practice location 3

817 Farrar Dr
Conway, SC 29526-8747
Phone (843) 234-1660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170626001151 SC Practitioner - Hematology/Oncology 8729301742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Cancer Center LLC 22 clinicians

Practice addresses (Care Compare)

817 Farrar Dr
Conway, SC 29526-8747
Phone (843) 234-1660

Hospital & facility affiliations

  • Amedisys Home Health of Conway Home health agency, Conway, SC, CCN 427112
  • Conway Medical Center Hospital, Conway, SC, CCN 420049
  • Grand Strand Regional Medical Center Hospital, Myrtle Beach, SC, CCN 420085

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
39910SCMDHematology & Oncology Physician

Practice roles (5 of 6)

OrganizationSpecialtyStatusNew patients
Coastal Cancer Center LLC Hematology & Oncology Current Accepting new patients
Coastal Cancer Center LLC Hematology & Oncology CurrentSince Apr 17, 2017 Accepting new patients
Coastal Cancer Center, LLC Hematology & Oncology Current Accepting new patients
Coastal Cancer Center LLC Hematology & Oncology CurrentSince Apr 17, 2017 Accepting new patients
Coastal Cancer Center LLC Hematology & Oncology Current Accepting new patients

Locations

817 Farrar Dr
Conway, SC 29526
Phone (843) 234-1660

3008 Bayboro St
Loris, SC 29569
Phone (843) 756-0932

4620 Highway 17
Murrells Inlet, SC 29576
Phone (843) 357-7357

8121 Rourk St
Myrtle Beach, SC 29572
Phone (843) 692-5000

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Organizations & group practices 5

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529625600000",
    "number": "1013200328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8121 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724128",
            "telephone_number": "843-692-5000",
            "fax_number": "843-429-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8121 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29572",
            "telephone_number": "843-692-5000",
            "fax_number": "843-692-5010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4620 Highway 17",
            "address_purpose": "LOCATION",
            "city": "Murrells Inlet",
            "state": "SC",
            "postal_code": "295765016",
            "country_code": "US",
            "telephone_number": "843-357-7357",
            "fax_number": "843-357-7358",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3008 Bayboro St",
            "address_purpose": "LOCATION",
            "city": "Loris",
            "state": "SC",
            "postal_code": "295692714",
            "country_code": "US",
            "telephone_number": "843-756-0932",
            "fax_number": "843-756-0508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "817 Farrar Dr",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "SC",
            "postal_code": "295268747",
            "country_code": "US",
            "telephone_number": "843-234-1660",
            "fax_number": "843-234-1661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JORDAN",
        "middle_name": "ANDREW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-18",
        "last_updated": "2018-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5101019226",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "39910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.