Kristi Dawn Henderson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K2922 Issued in TX

Practice address

1011 S William St
Atlanta, TX 75551-3245

Phone

(903) 796-2868

Fax

(903) 796-0826

NPI assigned

Aug 11, 2006

Last updated

Jan 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Kristi Miller Henderson Other name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Texas Tech University Health Science Center School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Round Table Physicians Group PLLCGroup PAC ID 0547682460, 80 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Round Table Physicians Group PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bellaire, TX
  • NPI 1023439114
  Medicare reassignment Care Compare group NPD
• Ellington Memorial Clinic, LLP

  • Rural Health Clinic/Center
  • Atlanta, TX
  • NPI 1760483770

  Family Medicine

  NPD
• Round Table Specialist Group, PLLC

  • Emergency Medicine Physician
  • Houston, TX
  • NPI 1497152268
  NPD
• Atlanta Hospital Authority

  dba Atlanta Memorial Hospital

  • Rural Acute Care Hospital
  • Atlanta, TX
  • NPI 1073600136
  NPD (past)
• Atlanta Hospital Authority

  dba Atlanta Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Atlanta, TX
  • NPI 1265514798
  NPD (past)
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1164433298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N LOUISE ST",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755511725",
            "telephone_number": "903-556-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 S WILLIAM ST",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755513245",
            "telephone_number": "903-796-2868",
            "fax_number": "903-796-0826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 Mall Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755032560",
            "country_code": "US",
            "telephone_number": "903-336-3412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KRISTI",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-2181",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K2922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIPS",
            "identifier": "119401",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8F1320",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "080181190",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096544403",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "A013",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5L214",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTI",
            "last_name": "HENDERSON",
            "middle_name": "MILLER",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Frances Healan
• Healthcare Express, LLP (HealthCARE Express)
• Healthcare Express, LLP (Healthcare Express)
• Mohamed Helal, MD
• Rachel Janeen Heldt, SLP/CCC
• Matthew James Hogan, MD
• Tim C Hogan, DDS
• Homesupply.Net
• Sunnie Smith Hooten, N.P.
• Richard Leroy Hozdic II, MD

• Family Medicine Physician in Atlanta, TX
• Providers in Atlanta, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.