Jerry Paul Henderson, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2021016736 Issued in MO

Practice address

5900 Byron Center Ave SW
Wyoming, MI 49519-9606

Phone

(616) 252-7604

NPI assigned

Jun 26, 2018

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

Medicare fee-for-service enrollment

Enrolled in MI, MO2 enrollments

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 2

Specialty

Emergency Medicine

Education

West Virginia School of Osteopathic Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hawk Emergency Group, P.C.Group PAC ID 6800241050, 55 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Healthcare Otsego Memorial Hospital Hospital, Gaylord, MI, CCN 230133

Merit-based Incentive Payment System (MIPS)

Final score

81.48 of 100Reported as individual

Quality

100

Improvement activities

0

Cost

84.14

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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 and National Provider Directory roles.

• Hawk Emergency Group, P.C.

  • Emergency Medicine Physician
  • Charlevoix, MI
  • NPI 1073295135
  Medicare reassignment Care Compare group NPD
• Camden Emergency Group LLC

  • Emergency Medicine Physician
  • Osage Beach, MO
  • NPI 1003181637
  Medicare reassignment NPD
• Ripley Emergency Group, LLC

  • Emergency Medicine Physician
  • Kirksville, MO
  • NPI 1720606023
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munson Healthcare Otsego Memorial Hospital

  • General Acute Care Hospital
  • Gaylord, MI
  • NPI 1124028972
  Care Compare affiliation

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1245725977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-7604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JERRY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-26",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "510123790",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2021016736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candace Alyce Heinlein
• Meredith Anne Heinlein, DNP
• Matison Heitman
• Sharon Renee Helmer, M.D.
• Jeffrey Mark Helmus, D.D.S
• Pamela Kay Henion, FNP-BC
• Adam Campbell Henke, M.D.
• Antonia Jocelyn Henry, M.D.
• Emma Jean Heppler, DO
• Nicolette Herbert, DO

• Emergency Medicine Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.