NPIMap

Individual provider Active NPI

Margot D Henderson, P.A.-C.

  • Medical Physician Assistant
  • Kingman, AZ
National Provider Identifier
1023092822
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2798 Issued in AZ
Practice address
1755 Airway Ave
Kingman, AZ 86409-3620
Phone
(928) 681-1234
Fax
(928) 681-1811
NPI assigned
Dec 5, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2798 AZ Primary

Addresses

Primary practice location

1755 Airway Ave
Kingman, AZ 86409-3620

Mailing address

3900 Stockton Hill Rd Ste B368
Kingman, AZ 86409-3029
Phone (928) 681-1234

Other identifiers 2

IdentifierTypeStateIssuer
827149MedicaidAZ
P00256908OtherAZRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20040309000549 AZ Practitioner - Physician Assistant 0749178911 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hematology-Oncology Associates of North Jersey LLCGroup PAC ID 4789674920, 4 clinicians

Practice addresses (Care Compare)

1755 Airway Ave
Kingman, AZ 86409-3620
Phone (928) 681-1234

3003 Hwy 95
Suite G73
Bullhead City, AZ 86442-7860
Phone (928) 219-4560

3555 Western Ave
Kingman, AZ 86409-3291
Phone (928) 757-8440

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2798AZMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kingman Oncology Institute LLC Past Accepting new patients
Hematology Oncology Associates of North Jersey, LLC Past Accepting new patients
Banner-University Medical Group Past Accepting new patients

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 4

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": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453334400000",
    "number": "1023092822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 STOCKTON HILL RD STE B368",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093029",
            "telephone_number": "928-681-1234",
            "fax_number": "928-681-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 AIRWAY AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093620",
            "telephone_number": "928-681-1234",
            "fax_number": "928-681-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MARGOT",
        "middle_name": "D",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2016-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "2798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "827149",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00256908",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

Verify at the official NPI Registry.