NPIMap

Individual provider Active NPI

William D Henceroth II, MD

  • Orthopaedic Surgery Physician
  • Clarksdale, MS
National Provider Identifier
1518952613
Registry record updated Mar 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
0101025812 Issued in VA
Practice address
785 Ohio Ave
Suite 1H
Clarksdale, MS 38614-6217
Phone
(662) 621-2438
Fax
(662) 621-2469
NPI assigned
Sep 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 0101025812 VA Primary
Orthopaedic Surgery Physician 207X00000X 21213 MS

Addresses

Primary practice location

785 Ohio Ave
Suite 1H
Clarksdale, MS 38614-6217

Mailing address

785 Ohio Ave
Suite 1H
Clarksdale, MS 38614-6217
Phone (662) 621-2438

Other identifiers 1

IdentifierTypeStateIssuer
010012449MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Retreat Cardiology LLC Past Accepting new patients
Orthopedic Specialists LLC Orthopaedic Surgery Past Accepting new patients
Delta Physician Practices Past Accepting new patients
Wythe County Physician Practices LLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1518952613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 OHIO AVE",
            "address_2": "SUITE 1H",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146217",
            "telephone_number": "662-621-2438",
            "fax_number": "662-621-2469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 OHIO AVE",
            "address_2": "SUITE 1H",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146217",
            "telephone_number": "662-621-2438",
            "fax_number": "662-621-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENCEROTH",
        "first_name": "WILLIAM",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "VA",
            "license": "0101025812",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MS",
            "license": "21213",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010012449",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.