Jacqueline Henderson, MD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

01059200A Issued in IN

Practice address

301 W Homer St
Michigan City, IN 46360-4358

Phone

(219) 879-8511

NPI assigned

Jun 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Epmg of Indiana, PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Hobart, IN
  • NPI 1750317350

  Emergency Medical Services

  NPD (past)
• Alteon Health New Mexico LLC

  • Emergency Medicine Physician
  • Hobbs, NM
  • NPI 1457636706
  NPD (past)
• Enchanted Desert Emergency Physicians LLC

  • Emergency Medicine Physician
  • Deming, NM
  • NPI 1861441529
  NPD (past)
• Epmg of Illinois LLC

  • Emergency Medicine Physician
  • Kankakee, IL
  • NPI 1528098902
  NPD (past)
• Epmg of Michigan, P.C.

  • Emergency Medicine Physician
  • Livonia, MI
  • NPI 1386688992
  NPD (past)
• Epmg of Ohio Inc P a

  • Emergency Medicine Physician
  • Portsmouth, OH
  • NPI 1841232196
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1366482358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 GREEN RD",
            "address_2": "SUITE 300",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481051598",
            "telephone_number": "734-995-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W HOMER ST",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463604358",
            "telephone_number": "219-879-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JACQUELINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IN",
            "license": "01059200A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Healthlinc Pharmacy, LLC
• Healthlinc, Inc.
• Healthlinc, Inc.
• Healthpartners Medical Group, LLC
• Helping Hands in-Home Care, Inc
• Justin Richard Henderson
• Hendricks County Hospital
• Jeff Hendricks, PHARMD
• John August Hendricks
• Madison S Hentgen, FNP-C

• All providers in Michigan City, IN
• Emergency Medical Services (Emergency Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.