Derek Allen Henderson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006108 Issued in MI

Practice address

1045 E Front St
Buchanan, MI 49107-8474

Phone

(269) 695-5540

Fax

(269) 695-0412

NPI assigned

Aug 23, 2011

Last updated

Oct 13, 2016By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Lakeland Hospitals St Joseph Hospital Home health agency, Benton Harbor, MI, CCN 237163
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dhenderson1269890@epic00.corewelldirect.org

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.

• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment Care Compare group
• Psychiatric Specialties, PLC

  • Psychiatry Physician
  • Saint Joseph, MI
  • NPI 1841321072
  Medicare reassignment
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD
• Psychiatric and Psychological Specialties

  • Clinical Psychologist
  • Saint Joseph, MI
  • NPI 1548672728
  NPD (past)

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

• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals St. Joseph Hospital

  • Home Health Agency
  • Benton Harbor, MI
  • NPI 1912094525
  Care Compare affiliation

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1447530498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437",
            "city": "BUCHANAN",
            "state": "MI",
            "postal_code": "491070437",
            "telephone_number": "269-695-0262",
            "fax_number": "269-695-2590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 E FRONT ST",
            "city": "BUCHANAN",
            "state": "MI",
            "postal_code": "491078474",
            "telephone_number": "269-695-5540",
            "fax_number": "269-695-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DEREK",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-23",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Gillis, DPT
• Kathy Carlene Hagley, MMT
• Robyn Fae Harbaugh, LPN
• Harold Brown MD (Physicians Health Care)
• John M. Harrington, HEARING AID DEALER
• Corrine Hoetger
• Homewatch Senior Care LLC
• Into His Rest Ministries
• JBJ DDS, PLLC
• John M Berecz PHD Abpp LLC

• Physician Assistant in Buchanan, MI
• Providers in Buchanan, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.