NPIMap

Individual provider Active NPI

Kathleen Henderson, MSN, CRNP

  • Adult Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1477759264
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
VP004751X Issued in PA
Practice address
333 Cottman Ave
Philadelphia, PA 19111-2434
Phone
(215) 707-3677
NPI assigned
Jun 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X VP004751X PA Primary

Addresses

Primary practice location

333 Cottman Ave
Philadelphia, PA 19111-2434

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 453-3300

Other practice location 1

915 Lawn Ave Ste 202
Sellersville, PA 18960-1551
Phone (215) 453-3300

Other identifiers 1

IdentifierTypeStateIssuer
1022773590001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071106000026 PA Practitioner - Nurse Practitioner 5991892192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-5030

Hospital & facility affiliations

  • Temple University Hospital Hospital, Philadelphia, PA, CCN 390027
  • Hospital of the Fox Chase Cancer Center Hospital, Philadelphia, PA, CCN 390196
  • Doylestown Hospital Hospital, Doylestown, PA, CCN 390203

Merit-based Incentive Payment System (MIPS)

Final score
81.21 of 100Reported as group
Quality
49.71
Promoting interoperability
100
Improvement activities
40
Cost
74.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
VP004751XPAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Dec 1, 2020 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Dec 1, 2020 Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

2365 Heritage Center Dr
Furlong, PA 18925
Phone (215) 728-3883

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

7600 Central Ave
Philadelphia, PA 19111
Phone (215) 707-5522

333 Cottman Ave
Philadelphia, PA 19111
Phone (215) 728-3893

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1477759264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-453-3300",
            "fax_number": "215-453-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-707-3677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "915 Lawn Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Sellersville",
            "state": "PA",
            "postal_code": "189601551",
            "country_code": "US",
            "telephone_number": "215-453-3300",
            "fax_number": "215-453-3306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KATHLEEN",
        "credential": "MSN, CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "VP004751X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022773590001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.