Kevin M Henry, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

036114669 Issued in IL

Practice address

5401 N Knoxville Ave
Suite 416
Peoria, IL 61614-5098

Phone

(309) 692-7246

Fax

(309) 692-7226

NPI assigned

Jan 9, 2006

Last updated

Jan 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pain ManagementAlso: Anesthesiology

Education

Wayne State University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pain Institute of Southern Arizona Pisa PCGroup PAC ID 4688615362, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Ironwood Medical Center Hospital, Queen Creek, AZ, CCN 030130

Merit-based Incentive Payment System (MIPS)

Final score

45.68 of 100Reported as group

Quality

40.49

Promoting interoperability

0

Improvement activities

30

Cost

74.27

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72783
• FHIR API: https://fhir4.healow.com/fhir/r4/EAIIBA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pain Institute of Southern Arizona Pisa PC

  • Pain Medicine (Anesthesiology) Physician
  • Tucson, AZ
  • NPI 1861575078
  Medicare reassignment Care Compare group NPD
• Southwest Pain & Spine Center LLC

  • Specialist
  • Queen Creek, AZ
  • NPI 1811369358
  NPD (past) Authorized official
• Pain Institute of Southern Arizona Pisa PC

  dba Regional Pain Institute

  • Pain Medicine (Anesthesiology) Physician
  • San Tan Valley, AZ
  • NPI 1780268912
  NPD
• Regional Pain Institute, LLC

  • Specialist
  • San Tan Valley, AZ
  • NPI 1992118673
  NPD
• Andrew Kim, DO PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Henderson, NV
  • NPI 1679980692
  NPD (past)
• Southern Nevada Pain Center Kim PC

  dba Southern Nevada Pain Center

  • Interventional Pain Medicine Physician
  • Las Vegas, NV
  • NPI 1073624011
  NPD (past)

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

• Banner Ironwood Medical Center

  • General Acute Care Hospital
  • Queen Creek, AZ
  • NPI 1124341672
  Care Compare affiliation

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357776000000",
    "number": "1063490183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 416",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-692-7246",
            "fax_number": "309-692-7226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 416",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-692-7246",
            "fax_number": "309-692-7226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "KEVIN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-09",
        "last_updated": "2013-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036114669",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NV",
            "license": "10492",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036114669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114669",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David K Hendricksen, M.D.
• Jamie Hendrickson, MS, RDN, LDN
• Mena Henien, MD
• Jeffrey R Henline, OD
• Jesse Lee Henneberg, APN
• Robin Dawn Henry, RN
• Elizabeth Hensold
• Grace Elizabeth Hensold, RDN, LDN
• Samantha Henson
• Bryan Heppe, CRNA

• Pain Medicine (Anesthesiology) Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Pain Medicine (Anesthesiology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.