Glenn H Henderson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2228 Issued in FL

Practice address

1300 Miccosukee Rd
Hospitalist Group
Tallahassee, FL 32308-5054

Phone

(850) 431-4997

Fax

(850) 431-6315

NPI assigned

Jul 28, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tallahassee Memorial Healthcare IncGroup PAC ID 6103724778, 498 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ghenderson21469@tallahasseememorial.direct-ci.com

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.

• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Medicare reassignment Care Compare group
• Tallahassee Memorial Healthcare Inc

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1053616375
  NPD
• Tallahassee Memorial Healthcare Inc

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1366293102
  NPD
• Southern Medical Group, PA

  • Cardiovascular Disease Physician
  • Tallahassee, FL
  • NPI 1417948159
  NPD (past)

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

• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Care Compare affiliation

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1477567279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MICCOSUKEE RD",
            "address_2": "HOSPITALIST GROUP",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085054",
            "telephone_number": "850-431-4997",
            "fax_number": "850-431-6315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MICCOSUKEE RD",
            "address_2": "HOSPITALIST GROUP",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085054",
            "telephone_number": "850-431-4997",
            "fax_number": "850-431-6315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "GLENN",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA2228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2907232",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hematology Oncology Solutions of Tallahassee LLC
• Damirah Hemmings
• Majesty V Hemmingway
• Karl Hempel, M.D.
• Angela L. Henderson, PH.D.
• Jacob Patrick Henderson, MD
• Kiley Henderson, BCBA
• Nadine Henderson, APRN
• Tashanda C Henderson
• Joanne Marie Hendricks

• Physician Assistant in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.