Individual provider Active NPI

Andrew Henderson, PA

  • Physician Assistant
  • Bend, OR
National Provider Identifier
1164043972
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA207932 Issued in OR
Practice address
2200 NE Neff Rd Ste 302
Bend, OR 97701-4279
Phone
(541) 706-6915
Fax
(541) 706-6733
NPI assigned
May 4, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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 PA207932 OR Primary

Addresses

Primary practice location

2200 NE Neff Rd Ste 302
Bend, OR 97701-4279

Mailing address

3355 Riverbend Dr Ste 300
Springfield, OR 97477-8800
Phone (541) 868-9303

Other practice location 1

3355 Riverbend Dr Ste 300
Springfield, OR 97477-8800
Phone (541) 868-9303

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ahenderson191715@secure.stcharleshealthcare.org

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
I20211214002163 OR Practitioner - Physician Assistant 7214327881 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164

2500 NE Neff Rd
Bend, OR 97701-6015

Hospital & facility affiliations

  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA207932ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Jan 29, 2024 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2200 NE Neff Rd
Ste 302
Bend, OR 97701
Phone (541) 706-4220

2200 NE Neff Rd
Bend, OR 97701
Phone (541) 322-2323

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

Interoperability endpoints

  • Direct secure messaging: ahende57@yourcarecommunity.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1588550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1164043972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 RIVERBEND DR STE 300",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-868-9303",
            "fax_number": "541-868-9306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD STE 302",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014279",
            "telephone_number": "541-706-6915",
            "fax_number": "541-706-6733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3355 Riverbend Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974778800",
            "country_code": "US",
            "telephone_number": "541-868-9303",
            "fax_number": "541-868-9306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "ANDREW",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-04",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA207932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahenderson191715@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2200 NE Neff Rd Ste 302",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977014279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.