Individual provider Active NPI

Alexis Patrice Henderson

  • Pain Medicine Physician
  • Clearwater, FL
National Provider Identifier
1245431360
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
ME38866 Issued in FL
Practice address
51 S. Main Ave
Suite 318
Clearwater, FL 33765
Phone
(727) 420-9433
NPI assigned
May 29, 2007
Last updated
Sep 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X ME38866 FL Primary

Addresses

Primary practice location

51 S. Main Ave
Suite 318
Clearwater, FL 33765

Mailing address

51 S Main Ave Ste 318
Clearwater, FL 33765-3934
Phone (727) 572-6261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20170614000672 FL Order and Referring Only - Pain ManagementPractitioner - Pain Management 1456539311

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Careservices of Central Florida LLC Past Accepting new patients
Pain Care Management of Orlando, LLC Past Accepting new patients
SCC Group Inc Past Accepting new patients
Mobile Medical Industries Inc Past Accepting new patients
Pain Care Management of Clearwater, LLC PastSince Sep 25, 2019 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1245431360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 S MAIN AVE STE 318",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337653934",
            "telephone_number": "727-572-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 S. MAIN AVE",
            "address_2": "SUITE 318",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33765",
            "telephone_number": "727-420-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "ALEXIS",
        "middle_name": "PATRICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "FL",
            "license": "ME38866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.