Active NPI
Lee Frederic Henry, DO
- Body Imaging Physician
- Pella, IA
National Provider Identifier
1528036845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Body Imaging Physician
- License
- 02476
- Practice address
- 404 Jefferson St
Pella, IA 50219-1291 - Phone
- (641) 628-3150
- Fax
- (641) 628-8901
- NPI assigned
- Mar 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 02476 | IA | Primary |
Addresses
Primary practice location
404 Jefferson St
Pella, IA 50219-1291
Mailing address
404 Jefferson St
Pella, IA 50219-1291
Phone (641) 628-3150
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0321455 | Medicaid | IA | |
| 300036501 | Other | IA | RAILROAD MEDICARE |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02476 | IA | MD | Body Imaging Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192406400000",
"number": "1528036845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 JEFFERSON ST",
"city": "PELLA",
"state": "IA",
"postal_code": "502191291",
"telephone_number": "641-628-3150",
"fax_number": "641-628-8901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 JEFFERSON ST",
"city": "PELLA",
"state": "IA",
"postal_code": "502191291",
"telephone_number": "641-628-3150",
"fax_number": "641-628-8901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "LEE",
"middle_name": "FREDERIC",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-11",
"last_updated": "2007-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "IA",
"license": "02476",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0321455",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "300036501",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pella, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.