Mathew Henderson, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0102205248 Issued in VA

Practice address

1901 Denniston Ave SW
Roanoke, VA 24015-2023

Phone

(540) 613-8565

NPI assigned

Apr 9, 2015

Last updated

Jun 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Roanoke Pediatrics PLLC

  • Pediatrics Physician
  • Roanoke, VA
  • NPI 1760158208
  NPD Authorized official

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

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1215323837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 DENNISTON AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240152023",
            "telephone_number": "540-613-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 DENNISTON AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240152023",
            "telephone_number": "540-613-8565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MATHEW",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-09",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102205248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hemi House, LLC
• Megan Anne Hemmrich, DO
• Alexis H. Henderson, OTR
• Carl Star Henderson, D.O.
• Chanelle Henderson
• Robert Henderson, DO
• Haley Nicole Hendrix
• Jasmine Marie Hengeli
• Zoe Henkes, MD
• Bonnie Lynn Hennig-Trestman, LCSW

• Pediatrics Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.