Individual provider Active NPI

Isaac Nathaniel Henry, PA-C

  • Physician Assistant
  • Hemet, CA
National Provider Identifier
1154459709
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19039 Issued in CA
Practice address
1001 S State St
Hemet, CA 92543-7186
Phone
(951) 925-2525
NPI assigned
Mar 2, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA19039 CA Primary

Addresses

Primary practice location

1001 S State St
Hemet, CA 92543-7186

Mailing address

32206 One Half Lakeview Terrace
Lake Elsinore, CA 92530-0534
Phone (951) 445-6160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170602000516 TX Practitioner - Physician Assistant 0840376422 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanana Chiefs ConferenceGroup PAC ID 9537050109, 148 clinicians

Practice addresses (Care Compare)

1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA19039CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tanana Chiefs Conference CurrentSince Aug 16, 2022 Accepting new patients
Maniilaq Association CurrentSince Apr 22, 2017 Accepting new patients

Locations

1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682

Interoperability endpoints

  • Direct secure messaging: isaac.henry.1@15989.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154459709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32206 ONE HALF LAKEVIEW TERRACE",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925300534",
            "telephone_number": "951-445-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S STATE ST",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925437186",
            "telephone_number": "951-925-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "ISAAC",
        "middle_name": "NATHANIEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

Verify at the official NPI Registry.