Keith Allen Henry, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

01092894A Issued in IN

Practice address

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Phone

(260) 435-2772

NPI assigned

Aug 10, 2006

Last updated

Apr 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI, TX, NM3 enrollments

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 3

Specialty

Pathology

Education

University of Wisconsin School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mercy Health System Corporation

  dba MHS Physician Services

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment NPD
• Pathlink of New Mexico LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Las Cruces, NM
  • NPI 1437749272
  Medicare reassignment NPD
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  NPD
• Associated Pathologists LLC

  dba Anatomic Pathology Lab

  • Clinical Medical Laboratory
  • Nashville, TN
  • NPI 1124075635
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1447261201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 VIRGINIA WAY STE 300",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277542",
            "telephone_number": "615-221-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-435-2772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 Big Run Rd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405032903",
            "country_code": "US",
            "telephone_number": "859-278-9513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRY",
        "first_name": "KEITH",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "51606",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "KY",
            "license": "54071",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NM",
            "license": "MD2020-0138",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "30299",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01092894A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32093700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100668960",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ciara Henry
• Darryl Henry, MD
• Donald Henry
• Elizabeth Jennie Henry
• Kara A Henry
• Natalie Henry, RBT, BS
• Nathaniel Henry
• Adisyne Olivia Hensel
• Brian James Hensel
• Tori Hensinger

• Anatomic Pathology & Clinical Pathology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.