NPIMap

Organization Active NPI

Gregory L Henderson MD Facs Inc

  • Optometrist
  • Ruskin, FL
National Provider Identifier
1306830799
Registry record updated Sep 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GREGORY L HENDERSON MD FACS INC
Practice address
612 N Tamiami TRL
Ruskin, FL 33570-3769
Phone
(813) 645-3831
Fax
(813) 645-4402
NPI assigned
Aug 31, 2005
Organization subpart
Yes
Parent organization
GREGORY L HENDERSON MD FACS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2017

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

Authorized official

Name
Mr. Gregory L Henderson Sr., MDNPI 1427055227
Title
President
Phone
(813) 681-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

612 N Tamiami TRL
Ruskin, FL 33570-3769

Mailing address

403 Vonderburg Dr
Brandon, FL 33511-5982
Phone (813) 681-1122

Other identifiers 1

IdentifierTypeStateIssuer
060983801MedicaidFL

Other names 1

  • Florida Eye Specialist and Cataract Institute Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001097 FL Part B Supplier - Clinic/Group Practice 9739172321 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverview, FL; Tampa, FL; Sun City Center, FL; Ruskin, FL; Plant City, FL; Lake Wales, FL; Brandon, FL
O20100930031552 FL DME Supplier - Physician - OptometristDME Supplier - Optician 9739172321 Practice locations: Ruskin, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Gregory L Henderson MD Facs Inc612 N Tamiami TRL, Ruskin, FL 33570-3769(813) 645-3831 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Part of
Gregory L Henderson MD Facs

Locations

6152 Delancey Station St
Ste 101
Riverview, FL 33578
Phone (813) 643-7300

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505779200000",
    "number": "1306830799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 VONDERBURG DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115982",
            "telephone_number": "813-681-1122",
            "fax_number": "813-684-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N TAMIAMI TRL",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335703769",
            "telephone_number": "813-645-3831",
            "fax_number": "813-645-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY L HENDERSON MD FACS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREGORY L HENDERSON MD FACS INC",
        "enumeration_date": "2005-08-31",
        "last_updated": "2017-09-19",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-681-1122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060983801",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Eye Specialist and Cataract Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ruskin, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.