Individual provider Active NPI

John Henstrom, MD

  • Emergency Medicine Physician
  • Temple, TX
National Provider Identifier
1215564141
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
T3099 Issued in TX
Practice address
2401 S 31St St # 11Ag062
Temple, TX 76508-0001
Phone
(254) 724-5815
NPI assigned
Mar 23, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X T3099 TX Primary

Addresses

Primary practice location

2401 S 31St St # 11Ag062
Temple, TX 76508-0001

Mailing address

2401 S 31St St # 11Ag062
Temple, TX 76508-0001

Other practice location 1

2026 S Jackson St
Jacksonville, TX 75766-5822
Phone (903) 586-5768

Other practice location 2

3203 S Main St
Lindale, TX 75771-7727
Phone (903) 266-4000

Other practice location 3

115 Airport Rd
Sulphur Springs, TX 75482-2105
Phone (903) 885-7671

Other practice location 4

8389 S Broadway Ave
Tyler, TX 75703-5408
Phone (903) 606-6500

Other practice location 5

719 W Coke Rd
Winnsboro, TX 75494-3011
Phone (903) 342-5227

Other practice location 6

18780 Interstate 20
Canton, TX 75103-3593
Phone (903) 567-4841

Other practice location 7

800 E Dawson St
Tyler, TX 75701-2036
Phone (903) 606-4262

Other practice location 8

1509 S Palestine St
Athens, TX 75751-8950
Phone (903) 606-4262

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230927001474 TX Practitioner - Emergency Medicine 4981035896 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Texas Emergency Physicians PLLCGroup PAC ID 8527420306, 195 clinicians

Practice addresses (Care Compare)

115 Airport Rd
Sulphur Springs, TX 75482-2105
Phone (903) 885-7671

5414 S Broadway Ave
Christus Mother Frances Hospital
Tyler, TX 75703-1335
Phone (903) 531-5010

800 E Dawson St
Tyler, TX 75701-2036

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T3099TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Aug 1, 2023 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 1, 2023 Accepting new patients
Northeast Texas Emergency Physicians, PLLC Emergency Medicine CurrentSince Oct 1, 2023 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Aug 1, 2023 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Aug 1, 2023 Accepting new patients

Locations

1509 State Highway 19 S
Athens, TX 75751
Phone (903) 606-4262

1007 S William St
Atlanta, TX 75551
Phone (903) 614-2000

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

115 Airport Rd
Sulphur Springs, TX 75482
Phone (903) 439-4052

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

8389 S Broadway Ave
Tyler, TX 75703
Phone (903) 606-4129

719 W Coke Rd
Winnsboro, TX 75494
Phone (903) 342-3961

Interoperability endpoints

  • Direct secure messaging: jhenstrom317237@christushealth.direct-ci.net

Organizations & group practices 5

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 1

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": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1215564141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST # 11AG062",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST # 11AG062",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-5815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2026 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "TX",
            "postal_code": "757665822",
            "country_code": "US",
            "telephone_number": "903-586-5768",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3203 S Main St",
            "address_purpose": "LOCATION",
            "city": "Lindale",
            "state": "TX",
            "postal_code": "757717727",
            "country_code": "US",
            "telephone_number": "903-266-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Airport Rd",
            "address_purpose": "LOCATION",
            "city": "Sulphur Springs",
            "state": "TX",
            "postal_code": "754822105",
            "country_code": "US",
            "telephone_number": "903-885-7671",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8389 S Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757035408",
            "country_code": "US",
            "telephone_number": "903-606-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "719 W Coke Rd",
            "address_purpose": "LOCATION",
            "city": "Winnsboro",
            "state": "TX",
            "postal_code": "754943011",
            "country_code": "US",
            "telephone_number": "903-342-5227",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18780 Interstate 20",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "TX",
            "postal_code": "751033593",
            "country_code": "US",
            "telephone_number": "903-567-4841",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 E Dawson St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012036",
            "country_code": "US",
            "telephone_number": "903-606-4262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1509 S Palestine St",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "TX",
            "postal_code": "757518950",
            "country_code": "US",
            "telephone_number": "903-606-4262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENSTROM",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "T3099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.