Peter Paul Moheb Hennis, AGNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

258473 Issued in AZ

Practice address

520 N Camino Mercado Ste 1
Casa Grande, AZ 85122-5754

Phone

(520) 557-5600

Fax

(480) 494-2771

NPI assigned

Jun 18, 2021

Last updated

Oct 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bonhoeffer Rheumatology Institute LLCGroup PAC ID 1850601360, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JGIFDD

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.

• Bonhoeffer Rheumatology Institute, LLC

  • Rheumatology Physician
  • Gilbert, AZ
  • NPI 1811372345
  Medicare reassignment Care Compare group NPD
• Azure Medical PC

  • Rheumatology Physician
  • Riverside, CA
  • NPI 1295596195

  AZ

  Medicare reassignment
• Optum Infusion Clinic, LLC

  • Infusion Therapy Clinic/Center
  • Phoenix, AZ
  • NPI 1891561999
  NPD (past)

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1588233175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342471",
            "telephone_number": "480-494-2770",
            "fax_number": "480-494-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N CAMINO MERCADO STE 1",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225754",
            "telephone_number": "520-557-5600",
            "fax_number": "480-494-2771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2451 E Baseline Rd Ste 425",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852340049",
            "country_code": "US",
            "telephone_number": "480-494-2770",
            "fax_number": "480-494-2771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNIS",
        "first_name": "PETER",
        "middle_name": "PAUL MOHEB",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-18",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "258473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helping Associates Inc
• Helping Associates, Inc.
• Matthew Hemm, PHYSICIAN ASSISTANT
• Minell Henderson
• Stacy Henderson
• Henry L Givre MD FCCP PC (Henry L Givre MD)
• Heritage Home Health Care of Arizonia
• Lydia Herman, PT, DPT
• Kylie Janae Hernandez-Rendon
• Destin Joseph Hernandez

• Gerontology Nurse Practitioner in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.