Active NPI
Anita Henderson, MD
- Family Medicine Physician
- Boone, NC
National Provider Identifier
1235117862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 24914
- Practice address
- 950 State Farm Rd
Boone, NC 28607-5021 - Phone
- (828) 264-0550
- Fax
- (828) 262-3529
- NPI assigned
- Jan 4, 2006
- Last updated
- May 21, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 24914 | NC | Primary |
Addresses
Primary practice location
950 State Farm Rd
Boone, NC 28607-5021
Mailing address
950 State Farm Rd
Boone, NC 28607-5021
Phone (828) 264-0550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8941375 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24914 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watauga Medical Center Inc | Past | Accepting new patients | |
| Watauga Medical Center, Inc. | Past | Accepting new patients | |
| Eagle Physicians and Associates PA | Past | Accepting new patients |
Organizations & group practices 3
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1235117862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 STATE FARM RD",
"city": "BOONE",
"state": "NC",
"postal_code": "286075021",
"telephone_number": "828-264-0550",
"fax_number": "828-262-3529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 STATE FARM RD",
"city": "BOONE",
"state": "NC",
"postal_code": "286075021",
"telephone_number": "828-264-0550",
"fax_number": "828-262-3529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "ANITA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-04",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "24914",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8941375",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boone, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.