Active NPI
Edward Kip Hensley, MD
- Plastic and Reconstructive Surgery Physician
- Merced, CA
National Provider Identifier
1073597852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- G43201
- Practice address
- 411 W 20TH St
Merced, CA 95340-3713 - Phone
- (209) 722-8122
- Fax
- (209) 722-9849
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | G43201 | CA | Primary |
Addresses
Primary practice location
411 W 20TH St
Merced, CA 95340-3713
Mailing address
411 W 20TH St
Merced, CA 95340-3713
Phone (209) 722-8122
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G432010 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43201 | CA | MD | Marriage & Family Therapist |
| G43201 | CA | MD | Plastic and Reconstructive Surgery Physician |
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": "1263254400000",
"number": "1073597852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 W 20TH ST",
"city": "MERCED",
"state": "CA",
"postal_code": "953403713",
"telephone_number": "209-722-8122",
"fax_number": "209-722-9849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 W 20TH ST",
"city": "MERCED",
"state": "CA",
"postal_code": "953403713",
"telephone_number": "209-722-8122",
"fax_number": "209-722-9849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSLEY",
"first_name": "EDWARD",
"middle_name": "KIP",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "CA",
"license": "G43201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G432010",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merced, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.