James Martin Henderson, M.D./DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

20470 Issued in WV

Practice address

415 Morris St
Suite 309
Charleston, WV 25301-1842

Phone

(304) 388-3290

Fax

(304) 388-3186

NPI assigned

Apr 12, 2006

Last updated

Jun 9, 2011By 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

  dba Mt State Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, WV
  • NPI 1073211637
  NPD
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

  dba Mt State Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, WV
  • NPI 1447711858
  NPD (past)
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Hurricane, WV
  • NPI 1992766737
  NPD (past)

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1295799963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST",
            "address_2": "SUITE 304",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011842",
            "telephone_number": "304-388-7782",
            "fax_number": "304-388-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST",
            "address_2": "SUITE 309",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011842",
            "telephone_number": "304-388-3290",
            "fax_number": "304-388-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JAMES",
        "middle_name": "MARTIN",
        "credential": "M.D./DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WV",
            "license": "20470",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "20470",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4002055001",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "850000287",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4002055-000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodian R Hemmings, DO
• Candi Henderson
• Chanya Henderson
• Ciahna Henderson
• Donna Henderson
• Justin Henderson
• Rachel A Henderson
• Crystal Hendricks
• Diane Briers Hendricks, MSW
• Carson Henley, DDS

• Oral & Maxillofacial Surgery (D.M.D.) in Charleston, WV
• Providers in Charleston, WV by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; 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.