Individual provider Active NPI

Kendall Eileen Henery, PA-C

  • Physician Assistant
  • Salem, OR
National Provider Identifier
1114670965
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5050 Skyline Village Loop S
Salem, OR 97306-9490
Phone
(503) 391-1110
NPI assigned
Feb 1, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X PA206842 OR

Addresses

Primary practice location

5050 Skyline Village Loop S
Salem, OR 97306-9490

Mailing address

1340 Elser Dr SE
Salem, OR 97302-1861
Phone (503) 559-3362

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220328000404 OR Practitioner - Physician Assistant 2769877885 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

5050 Skyline Village Loop S
Salem, OR 97306-9490
Phone (503) 391-1110

665 Winter St SE
Salem, OR 97301-3934
Phone (503) 561-5200

Hospital & facility affiliations

  • First Call Home Health Agency, LLC Home health agency, Salem, OR, CCN 387147
  • Salem Hospital Hospital, Salem, OR, CCN 380051
  • Salem Health West Valley Hospital, Dallas, OR, CCN 381308

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health Single Specialty CurrentSince Apr 10, 2022 Accepting new patients

Locations

1000 SE Uglow Ave
Dallas, OR 97338
Phone (503) 623-8376

1601 Monmouth St
Ste 100
Independence, OR 97351
Phone (503) 623-8301

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

5050 Skyline Village Loop S
Salem, OR 97306
Phone (503) 291-2123

Interoperability endpoints

  • Direct secure messaging: khenery335579@direct.salemhealth.org

Organizations & group practices 3

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 3

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": "1643673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1114670965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 ELSER DR SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021861",
            "telephone_number": "503-559-3362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 SKYLINE VILLAGE LOOP S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069490",
            "telephone_number": "503-391-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENERY",
        "first_name": "KENDALL",
        "middle_name": "EILEEN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "PA206842",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.