Jeffrey Harris Henderson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2011-00070 Issued in NC

Practice address

170 Kimel Park Dr
Winston Salem, NC 27103-6946

Phone

(704) 323-2000

NPI assigned

Aug 26, 2008

Last updated

Jul 21, 2022By 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 2

Addresses

Other identifiers 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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jhenderson@sos1359.srs-direct.com

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.

• The Moses H Cone Memorial Hospital Operating Corporation

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1356372064

  Family Medicine

  Medicare reassignment NPD
• The Moses H Cone Memorial Hospital Operating Corporation

  dba Cone Health Community Pharmacy at Eden

  • Community/Retail Pharmacy
  • Eden, NC
  • NPI 1861222507
  NPD
• Bayfront Enterprises Inc

  dba Bayfront Convenient Care Clinics

  • Urgent Care Clinic/Center
  • St Petersburg, FL
  • NPI 1710963236
  NPD (past)

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1235386848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD",
            "address_2": "SUITE 250",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093239",
            "telephone_number": "704-323-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 KIMEL PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "704-323-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 Pineview Dr",
            "address_2": "Suite 220",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272843817",
            "country_code": "US",
            "telephone_number": "704-323-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JEFFREY",
        "middle_name": "HARRIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2011-00070",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NC",
            "license": "2011-00070",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497704217",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Henao, M.D.
• Paula A Henao, DDS
• Andrew Scott Henderson, PA-C
• Brittany Henderson
• Emily Kaitlin Henderson
• Kamal Hanee Henderson, MD
• Katherine Beier Henderson
• Leah A Henderson, NA I, COTA/L
• Michaela Simone Henderson, MS, LCMHCA, NCC
• Rebecca Myer Henderson, MD PHD

• Family Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.