Individual provider Active NPI

Jeremy W. Henderson, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Birmingham, AL
National Provider Identifier
1336359652
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
27082 Issued in AL
Practice address
619 19TH St S
Birmingham, AL 35249-1900
Phone
(205) 934-5038
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 27082 AL Primary

Addresses

Primary practice location

619 19TH St S
Birmingham, AL 35249-1900

Mailing address

2293 Ascot LN
Birmingham, AL 35216-6133
Phone (205) 934-4303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20100825000412 LA Practitioner - Pathology 3971656695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Louisiana State University School of Medicine in New Orleans, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Delta Pathology Group LLCGroup PAC ID 4789639089, 28 clinicians

Practice addresses (Care Compare)

1202 S Tyler St
Covington, LA 70433-2330
Phone (985) 898-4097

2915 Missouri Ave
Shreveport, LA 71109-4327
Phone (318) 364-2000

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-4640

Hospital & facility affiliations

  • St Tammany Parish Hospital Hospital, Covington, LA, CCN 190045

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. 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

OrganizationSpecialtyStatusNew patients
The Delta Pathology Group LLC Anatomic Pathology & Clinical Pathology Current Accepting new patients
The Delta Pathology Group LLC Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2012 Accepting new patients
The Delta Pathology Group, L.L.C. Past Accepting new patients

Locations

211 4th St
Alexandria, LA 71301
Phone (318) 473-3000

95 Judge Tanner Blvd
Covington, LA 70433
Phone (504) 867-3800

4600 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 371-3135

309 Jackson St
Monroe, LA 71201
Phone (318) 966-4000

2915 Missouri Ave
Shreveport, LA 71109
Phone (318) 364-2000

3290 Knight St
Shreveport, LA 71105
Phone (318) 621-8820

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1336359652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2293 ASCOT LN",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352166133",
            "telephone_number": "205-934-4303",
            "fax_number": "205-934-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 19TH ST S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352491900",
            "telephone_number": "205-934-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JEREMY",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AL",
            "license": "27082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.