NPIMap

Organization Active NPI

Gregory L Henderson MD Facs Inc

  • Ophthalmology Physician
  • Brandon, FL
National Provider Identifier
1144214552
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
GREGORY L HENDERSON MD FACS INC
Practice address
135 W Robertson St
Brandon, FL 33511-5111
Phone
(813) 685-0001
Fax
(813) 685-0008
NPI assigned
Aug 31, 2005
Organization subpart
Yes
Parent organization
GREGORY L HENDERSON MD FACS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Gregory L Henderson Sr., MDNPI 1427055227
Title
President
Phone
(813) 681-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

135 W Robertson St
Brandon, FL 33511-5111

Mailing address

403 Vonderburg Dr
Brandon, FL 33511-5982
Phone (813) 681-1122

Other identifiers 2

IdentifierTypeStateIssuer
060983803MedicaidFL
0609838-03MedicaidFL

Other names 1

  • Florida Eye Specialists and Cataract Institute Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040722001097 FL Part B Supplier - Clinic/Group Practice 9739172321 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverview, FL; Tampa, FL; Sun City Center, FL; Ruskin, FL; Plant City, FL; Lake Wales, FL; Brandon, FL

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Gregory L Henderson MD Facs

Locations

403 Vonderburg Dr
Fl Eye
Brandon, FL 33511
Phone (813) 681-1122

135 W Robertson St
Brandon, FL 33511
Phone (813) 685-0001

13106 Vail Ridge Dr
Riverview, FL 33579
Phone (813) 392-3311

1701 Rickenbacker Dr
Ste 102
Sun City Center, FL 33573
Phone (813) 634-8877

711 S Howard Ave
Tampa, FL 33606

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1144214552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 VONDERBURG DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115982",
            "telephone_number": "813-681-1122",
            "fax_number": "813-684-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 W ROBERTSON ST",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115111",
            "telephone_number": "813-685-0001",
            "fax_number": "813-685-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY L HENDERSON MD FACS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREGORY L HENDERSON MD FACS INC",
        "enumeration_date": "2005-08-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-681-1122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060983803",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0609838-03",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Eye Specialists and Cataract Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.