Active NPI
Charles Edward Henley, DO
- Family Medicine Physician
- Indianapolis, IN
National Provider Identifier
1154393049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 3508
- Practice address
- 1011 Main St
Indianapolis, IN 46224-6977 - Phone
- (317) 957-9050
- NPI assigned
- Feb 3, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3508 | OK | Primary |
Addresses
Primary practice location
1011 Main St
Indianapolis, IN 46224-6977
Mailing address
6626 E 75TH St
Ste 500
Indianapolis, IN 46250-2805
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01588239 | Other | IN | RAILROAD PTAN |
| 100031740D | Medicaid | OK |
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 Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1154393049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6626 E 75TH ST",
"address_2": "STE 500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 MAIN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462246977",
"telephone_number": "317-957-9050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENLEY",
"first_name": "CHARLES",
"middle_name": "EDWARD",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-03",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "3508",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD PTAN",
"identifier": "P01588239",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100031740D",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.