Nathan Ray Henderson, M.D.
Individual provider Active NPI Family Medicine Physician · Dover, AR
NPI 1013250182 · NPPES record last updated May 10, 2017
Key facts
- NPI
- 1013250182
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E8951 (AR)
- Practice address
- 8970 Market St
Dover, AR 72837-9110 - Phone
- (479) 331-3880
- Fax
- (479) 331-3788
- NPI assigned
- Mar 27, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150928000657 | AR | Practitioner - Family Practice |
9133430085 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E8951 | AR | MD | Family Medicine Physician |
Practice roles (9 of 16)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Mary'S Physician Services LLC | Current |
Accepting new patients | |
| St Marys Physician Services, LLC | Current |
Accepting new patients | |
| Mercy Hospital Paris | Current |
Accepting new patients | |
| Mercy Hospital Ozark | Current |
Accepting new patients | |
| Mercy Hospital Paris | Current |
Accepting new patients | |
| Mercy Hospital Ozark | Current |
Accepting new patients | |
| Mercy Hospital Paris | Current |
Accepting new patients | |
| Ess Hospitalist LLC | Current |
Accepting new patients | |
| St Marys Physician Services, LLC | Past | Accepting new patients |
Locations
880 W Main St
Booneville, AR 72927
Phone (479) 675-2800
1015 Unity Rd
Crossett, AR 71635
Phone (870) 364-0590
8970 Market St
Dover, AR 72837
Phone (479) 331-3880
801 W River St
Ozark, AR 72949
Phone (479) 667-4138
500 E Academy St
Paris, AR 72855
Phone (479) 963-6101
101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345
Networks
- MS PPO
- MS PPO C-SNP
- devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
- MS PPO D-SNP
- TN PPO C-SNP
- devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
- TN PPO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E8951 | AR | Yes |
Addresses
Primary practice location
8970 Market St
Dover, AR 72837-9110
Mailing address
8970 Market St
Dover, AR 72837-9110
Phone (479) 331-3880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 210379001 | Medicaid | AR |
Other providers in Dover, AR
- Haley Michelle Edwards
- Lakyn Ann George
- Therese R. Graham
- Richard L. Harmon
- Paris Hatchett
- Carlee Hinkle
- Jennifer Jacobs
- Johnston Occupational Therapy LLC
- Hannah Jones
- Brittany Michelle Martin
All providers in Dover, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.