Active NPI
Jeffrey A. Henderson, M.D., M.P.H.
- Internal Medicine Physician
- Rapid City, SD
National Provider Identifier
1598856049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 3636
- Practice address
- 3200 Canyon Lake Drive
Rapid City, SD 57702 - Phone
- (605) 355-2429
- Fax
- (605) 716-4814
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 3636 | SD | Primary |
Addresses
Primary practice location
3200 Canyon Lake Drive
Rapid City, SD 57702
Mailing address
701 St. Joseph Street
Suite 204
Rapid City, SD 57701
Phone (605) 348-6100
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3636 | SD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598856049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 ST. JOSEPH STREET",
"address_2": "SUITE 204",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "57701",
"telephone_number": "605-348-6100",
"fax_number": "605-348-6990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 CANYON LAKE DRIVE",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "57702",
"telephone_number": "605-355-2429",
"fax_number": "605-716-4814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "JEFFREY",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "M.D., M.P.H.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "SD",
"license": "3636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.