Troy Henderson, CRNP
Individual provider Active NPI Primary Care Nurse Practitioner · Fultondale, AL
NPI 1609324003 · NPPES record last updated Sep 14, 2016
Key facts
- NPI
- 1609324003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 1-143199 (AL)
- Practice address
- 1604 Stouts Rd
Fultondale, AL 35068-1962 - Phone
- (205) 849-9811
- Fax
- (205) 250-9812
- NPI assigned
- Sep 14, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Champion Sports Medicine Birmingham, LLC
Birmingham Internal Medicine Associates, LLC
Practice addresses (Care Compare)
2050 Gadsden Hwy
Suite 104
Birmingham, AL 35235-3260
Phone (205) 655-7231
7191 Cahaba Valley Rd
Suite 300
Hoover, AL 35242-6461
Phone (205) 814-7206
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170302001783 | AL | Practitioner - Nurse Practitioner | 5496039877 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-143199 | AL | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norwood Clinic Inc | Current |
Accepting new patients | |
| Birmingham Internal Medicine Associates, LLC | Primary Care | Current |
Accepting new patients |
Locations
1604 Stouts Rd
Fultondale, AL 35068
Phone (205) 849-9811
339 Walker Chapel Plz
Ste 115
Fultondale, AL 35068
Phone (205) 250-6424
2244 North Rd
Gardendale, AL 35071
Phone (205) 418-1080
7191 Cahaba Valley Rd
Ste 300
Hoover, AL 35242
Phone (205) 930-2060
2038 Springdale Ln
Tarrant, AL 35217
Phone (205) 841-7665
Interoperability endpoints
- troy.henderson.1@15135.direct.athenahealth.com
- https://api.platform.athenahealth.com/25282/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 1-143199 | AL | Yes |
Addresses
Primary practice location
1604 Stouts Rd
Fultondale, AL 35068-1962
Mailing address
PO Box 830230
Birmingham, AL 35283-0230
Phone (205) 250-6845
Other providers in Fultondale, AL
- Jessica Hardin
- Lisa Woods Harris
- Hesham Aldean Hassan
- Robert Lewis Head II
- Hematology & Oncology Associates of Alabama LLC
- Gregory Griffin Hill
- Greggory Tyler Hood
- Regan B Howell Jr.
- Erin Howze
- Sharrold Denise Hudson
All providers in Fultondale, AL · Primary Care Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.