Individual provider Active NPI

Lucas Henderson, M.D.

  • Pediatrics Physician
  • Thornton, CO
National Provider Identifier
1356301683
Registry record updated Feb 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
46289 Issued in CO
Practice address
9197 Grant St # 200
Thornton, CO 80229-4361
Phone
(303) 450-3690
Fax
(303) 450-3699
NPI assigned
Mar 23, 2006
Last updated
Feb 10, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 46289 CO Primary

Addresses

Primary practice location

9197 Grant St # 200
Thornton, CO 80229-4361

Mailing address

9197 Grant St # 200
Thornton, CO 80229-4361
Phone (303) 450-3690

Other identifiers 4

IdentifierTypeStateIssuer
222975OtherMACONNECTICARE
30280OtherMAHEALTHNET
J28328OtherMABCBS
35676OtherMAHEALTH NEW ENGLAND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46289COMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Mountain Youth Medical & Nursing Consultants Inc Pediatrics Current Accepting new patients
HCA Healthone LLC Past Accepting new patients

Locations

9197 Grant St
Ste 200
Thornton, CO 80229
Phone (303) 450-3690

Interoperability endpoints

  • Direct secure messaging: lucas.henderson.1@14034.direct.athenahealth.com
  • Direct secure messaging: lucas.henderson@corhio.medicity.net

Organizations & group practices 2

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328832000000",
    "number": "1356301683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9197 GRANT ST # 200",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294361",
            "telephone_number": "303-450-3690",
            "fax_number": "303-450-3699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9197 GRANT ST # 200",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294361",
            "telephone_number": "303-450-3690",
            "fax_number": "303-450-3699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "LUCAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2012-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "46289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "222975",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "30280",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "J28328",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NEW ENGLAND",
            "identifier": "35676",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.