Individual provider Active NPI

Michael John Henderson, PA-C

  • Medical Physician Assistant
  • Largo, FL
National Provider Identifier
1558523951
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9113306 Issued in FL
Practice address
13670 Walsingham Rd
Largo, FL 33774-3532
Phone
(727) 315-6974
NPI assigned
Jun 26, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9113306 FL Primary

Addresses

Primary practice location

13670 Walsingham Rd
Largo, FL 33774-3532

Mailing address

13670 Walsingham Rd
Largo, FL 33774-3532

Other identifiers 1

IdentifierTypeStateIssuer
114317600MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Michael.hendersonpac@direct.mybaycare.org Health Information Exchange (HIE) BayCare Medical Group, Inc.

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20210831000845 FL Practitioner - Physician Assistant 7214090109 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Urgent Care, LLC.Group PAC ID 6103841051, 91 clinicians

Practice addresses (Care Compare)

10125 Big Bend Rd
Riverview, FL 33578-7417
Phone (813) 605-3200

1155 S Dale Mabry Hwy
Tampa, FL 33629-5035
Phone (813) 609-3666

13670 Walsingham Rd
Largo, FL 33774-3532
Phone (727) 593-9848

1599 66TH St N
St Petersburg, FL 33710-5536
Phone (727) 317-3388

2331 4TH St N
St Petersburg, FL 33704-2801
Phone (727) 914-8566

2442 Bloomingdale Ave
Valrico, FL 33596-6403
Phone (813) 586-8686

3351 N McMullen Booth Rd
Clearwater, FL 33761-2014
Phone (727) 314-4774

4821 US Hwy 19
Suite 5
New Port Richey, FL 34652-4259
Phone (727) 851-9650

711 S Belcher Rd
Clearwater, FL 33764-6326
Phone (727) 314-4848

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Medical Group, Inc. CurrentSince Jun 15, 2022 Accepting new patients
Baycare Urgent Care, LLC Current Accepting new patients
Ibg Healthcare Services LLC PastSince Jul 1, 2020 Accepting new patients
The Neighborhood Doctor PastSince Jul 1, 2020 Accepting new patients
Topcare Medical PA PastSince Apr 2, 2012 Accepting new patients

Locations

2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234

2461 Enterprise Rd
Ste C
Clearwater, FL 33763
Phone (727) 725-5060

13670 Walsingham Rd
Largo, FL 33774
Phone (727) 593-9848

4821 US Highway 19
Ste 5
New Port Richey, FL 34652
Phone (727) 851-9650

6633 Forest Ave
Ste 105
New Prt Rchy, FL 34653
Phone (727) 845-4300

2331 4th St N
St Petersburg, FL 33704
Phone (727) 593-9848

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 6

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 3

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": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1558523951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13670 WALSINGHAM RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337743532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13670 WALSINGHAM RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337743532",
            "telephone_number": "727-315-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9113306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114317600",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Michael.hendersonpac@direct.mybaycare.org",
            "affiliation": "Y",
            "affiliationName": "BayCare Medical Group, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2995 Drew St Fl 2",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337593012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.