Jessica Lynn Henderson, D.O.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

2010-00808 Issued in NC

Practice address

4420 Lake Boone Trail
Raleigh, NC 27607-2360

Phone

(919) 784-3100

NPI assigned

May 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Anesthesiology

Education

West Virginia School of Osteopathic Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Carolina Health - Heritage IncGroup PAC ID 4789582594, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vidant Edgecombe Hospital Hospital, Tarboro, NC, CCN 340107

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• East Carolina Health - Heritage Inc

  • Anesthesiology Physician
  • Tarboro, NC
  • NPI 1194703884

  Anesthesiology, NC

  Medicare reassignment Care Compare group NPD
• East Carolina Health - Heritage Inc

  • Rural Health Clinic/Center
  • Pinetops, NC
  • NPI 1821076589
  Care Compare group NPD
• East Carolina Health - Heritage Inc

  • General Acute Care Hospital
  • Tarboro, NC
  • NPI 1699757393
  Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• East Carolina Health - Heritage Inc

  • General Acute Care Hospital
  • Tarboro, NC
  • NPI 1699757393

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1174745665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SPRING FOREST RD",
            "address_2": "SUITE 130",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162880",
            "telephone_number": "919-873-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 LAKE BOONE TRAIL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276072360",
            "telephone_number": "919-784-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2010-00808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174745665",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jhenderson261333@direct.vidanthealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2100 Stantonsburg Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278342818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ciara Henderson
• Corey Alan Henderson, PHARM.D
• David Henderson, M.D.
• Elissa Henderson, ARNP
• Hunter Dean Henderson, PT, DPT
• John Wesley Henderson II, DO
• Joshua Mark Henderson, PA-C
• Paul Manning Henderson, M.D.
• Sage Renai Henderson
• Sharon Henderson

• All providers in Raleigh, NC
• Anesthesiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.