Individual provider Active NPI

Thomas J Henderson, M.S., CCC-A

  • Audiologist
  • Elizabeth City, NC
National Provider Identifier
1538315338
Registry record updated Sep 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
841 Issued in VA
Practice address
330 Camden Cswy
Suite a
Elizabeth City, NC 27909-6811
Phone
(252) 331-1494
Fax
(252) 331-0308
NPI assigned
Aug 12, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 841 VA Primary

Addresses

Primary practice location

330 Camden Cswy
Suite a
Elizabeth City, NC 27909-6811

Mailing address

PO Box 2443
Elizabeth City, NC 27906-2443
Phone (252) 331-1494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090305000589 NC Practitioner - Qualified Audiologist 9032275607 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Brody School of Medicine at East Carolina University, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

330 Camden Cswy
Elizabeth City, NC 27909-6804
Phone (252) 331-2437

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
841NCMDAcupuncturist
841VAMDAudiologist

Organizations & group practices 1

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": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253577600000",
    "number": "1538315338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2443",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279062443",
            "telephone_number": "252-331-1494",
            "fax_number": "252-331-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 CAMDEN CSWY",
            "address_2": "SUITE A",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279096811",
            "telephone_number": "252-331-1494",
            "fax_number": "252-331-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "M.S., CCC-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-12",
        "last_updated": "2009-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "VA",
            "license": "841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.