Individual provider Active NPI

John N Henry Jr., PAC

  • Physician Assistant
  • Newport, VT
National Provider Identifier
1023076643
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1089 Issued in NH
Practice address
189 Prouty Dr
Newport, VT 05855-9820
Phone
(802) 334-7331
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X AP1946 MA
Physician Assistant 363A00000X 027167 NY
Physician Assistant 363A00000X 1089 NH Primary

Addresses

Primary practice location

189 Prouty Dr
Newport, VT 05855-9820

Mailing address

1 Medical Center Dr
Lebanon, NH 03756-1000
Phone (603) 650-5704

Other practice location 1

1 Medical Center Dr
Lebanon, NH 03756-1000
Phone (603) 650-5704

Other practice location 2

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 561-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170926003828 VT Practitioner - Physician Assistant 5698798452 Reassigns benefits to 1 organization
I20211104000198 NY Practitioner - Physician Assistant 5698798452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Champlain Valley Physicians Hospital Medical CenterGroup PAC ID 2769396878, 356 clinicians

Practice addresses (Care Compare)

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 562-7100

Hospital & facility affiliations

  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1946MAMDOccupational Therapist
AP1946MAMDPhysician Assistant
1089NHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Country Hospital & Health Center Inc CurrentSince Jul 19, 2017 Accepting new patients
North Country Hospital & Health Center Inc Current Accepting new patients
North Country Hospital & Health Center Inc Current Accepting new patients
Champlain Valley Physicians Hospital Medical Center Physician Assistant CurrentSince Oct 1, 2021 Accepting new patients
North Country Hospital & Health Center Inc Current Accepting new patients

Locations

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

186 Medical Village Dr
#1
Newport, VT 05855
Phone (802) 334-3262

189 Prouty Dr
Newport, VT 05855
Phone (802) 334-3569

186 Medical Village Dr
Newport, VT 05855
Phone (802) 334-3520

Interoperability endpoints

  • Direct secure messaging: jhenry447264@direct.uvmhealth.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/4a15a283-6747-4ef7-984f-ce0e904fd6f0/

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1023076643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 PROUTY DR",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058559820",
            "telephone_number": "802-334-7331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037561000",
            "country_code": "US",
            "telephone_number": "603-650-5704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "75 Beekman St",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129011438",
            "country_code": "US",
            "telephone_number": "518-561-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRY",
        "first_name": "JOHN",
        "middle_name": "N",
        "name_suffix": "Jr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "AP1946",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027167",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport, VT

Sources for this page

Verify at the official NPI Registry.