Phedra Elizabeth Hennessee, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-02997 Issued in NC

Practice address

1210 New Garden Rd
Greensboro, NC 27410-2721

Phone

(336) 852-1915

NPI assigned

Jan 8, 2007

Last updated

Apr 22, 2021By the provider in NPPES

Sex

Female

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 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eagle Physicians and Associates PAGroup PAC ID 0244134468, 101 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Eagle Physicians and Associates PA

  dba Eagle Family Medicine @ Guilford College

  • Family Medicine Physician
  • Greensboro, NC
  • NPI 1457436982
  Medicare reassignment Care Compare group NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  NC

  Medicare reassignment
• Eagle Physicians and Associates PA

  dba Eagle Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Greensboro, NC
  • NPI 1396852570
  NPD (past)
• Eagle Physicians and Associates PA

  • Sleep Medicine (Internal Medicine) Physician
  • Greensboro, NC
  • NPI 1609070648
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1518015247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W WENDOVER AVE STE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274088438",
            "telephone_number": "336-274-6515",
            "fax_number": "336-691-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 NEW GARDEN RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274102721",
            "telephone_number": "336-852-1915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1210 New Garden Road",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "27410",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1210 New Garden Road",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "27410",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1210 New Garden Rd",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274102721",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1210 New Garden Rd",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274102721",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1210 New Garden Rd",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274102721",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1210 New Garden Rd",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274102721",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1210 New Garden Rd",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274102721",
            "country_code": "US",
            "telephone_number": "336-852-1915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "324 W Wendover Ave",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274088437",
            "country_code": "US",
            "telephone_number": "336-274-6515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "390 W Salem Ave",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271015861",
            "country_code": "US",
            "telephone_number": "336-721-2375",
            "fax_number": "336-721-2394",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "324 W Wendover Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274088438",
            "country_code": "US",
            "telephone_number": "336-274-6515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNESSEE",
        "first_name": "PHEDRA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102287",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01031818",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "phedra.hennessee@eaglep.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1210 New Garden Rd",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274102721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Henley Family Care
• Donna Henley
• Donnell Henley
• Thomas F Henley, M.D.
• Adam Ryan Henn, MD
• Jolene M Henning, EDD, ATC, LAT
• Cassandra Ray Henricks
• Alysha Henry, NCLMBT
• Ariel Henry
• Carrie Henry

• Physician Assistant in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.