Sidney E Henderson III, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD11619 Issued in OR

Practice address

1501 NE Medical Center Dr
Bend, OR 97701-6051

Phone

(541) 382-2811

NPI assigned

Jun 30, 2006

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365984000000",
    "number": "1437188935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "SIDNEY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2013-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD11619",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD11619",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024773",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "00743535",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Henderson, PT
• Jessica Ann Henderson, DMD
• Mike Daniel Henderson, D.O.
• Robin J Henderson, PSYD
• Russell Loyd Henderson, FNP-BC
• Stephanie Henderson
• Sylvia Dianne Henderson, LPC
• Tracy Renee Henderson
• Valerie Rose Henderson
• Abby P. Hendricks, M.D.

• Gastroenterology Physician in Bend, OR
• Providers in Bend, OR by specialty
• Gastroenterology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; 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.