Active NPI
Randall Wayne Henderson, BC-HIS
- Hearing Instrument Specialist
- Sun City, AZ
National Provider Identifier
1043334261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- Practice address
- 10404 W Coggins Dr
Suite 110
Sun City, AZ 85351-3437 - Phone
- (623) 974-9666
- Fax
- (623) 974-4813
- NPI assigned
- Mar 16, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 00729 | IA | |
| Hearing Instrument Specialist | 237700000X | Primary |
Addresses
Primary practice location
10404 W Coggins Dr
Suite 110
Sun City, AZ 85351-3437
Mailing address
2510 E Sunset Rd
Unit 5-260
Las Vegas, NV 89120-3511
Phone (702) 798-0113
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0227132 | Medicaid | IA | |
| 42150911900 | Medicaid | NE | |
| 348031700 | Other | DOL NUMBER |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00729 | IA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 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.
-
- Audiologist
- Sun City, AZ
- NPI 1356681316
Hearing Instrument Specialist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405641600000",
"number": "1043334261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2510 E SUNSET RD",
"address_2": "UNIT 5-260",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891203511",
"telephone_number": "702-798-0113",
"fax_number": "866-291-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10404 W COGGINS DR",
"address_2": "SUITE 110",
"city": "SUN CITY",
"state": "AZ",
"postal_code": "853513437",
"telephone_number": "623-974-9666",
"fax_number": "623-974-4813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "RANDALL",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "BC-HIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2014-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IA",
"license": "00729",
"primary": false
},
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0227132",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42150911900",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DOL NUMBER",
"identifier": "348031700",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Sun City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.