Individual provider Active NPI

Courtney Elizabeth Henninger, FNP

  • Family Medicine Physician
  • Rochester, NY
National Provider Identifier
1629829957
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
353862 Issued in NY
Practice address
1455 E Ridge Rd
Rochester, NY 14621-2006
Phone
(585) 922-2575
NPI assigned
Mar 27, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 353862 NY Primary

Addresses

Primary practice location

1455 E Ridge Rd
Rochester, NY 14621-2006

Mailing address

55 Mill St
Waterloo, NY 13165-1640
Phone (315) 719-7974

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20240920000849 NY Practitioner - Nurse Practitioner 7113468943 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital Family Medicine CurrentSince Jun 10, 2024 Accepting new patients
Western New York Medical Practice P.C. Family Medicine CurrentSince Jan 5, 2026 Accepting new patients
Rochester General Hospital CurrentSince Jun 10, 2024 Accepting new patients
Western New York Medical Practice P.C CurrentSince Jan 5, 2026 Accepting new patients

Locations

833 Canandaigua Rd
Geneva, NY 14456
Phone (315) 210-1331

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

1455 E Ridge Rd
Rochester, NY 14621
Phone (585) 922-4103

Interoperability endpoints

  • Direct secure messaging: chenniger202165@direct.rochesterregional.org

Organizations & group practices 4

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": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1629829957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MILL ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651640",
            "telephone_number": "315-719-7974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 E RIDGE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146212006",
            "telephone_number": "585-922-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNINGER",
        "first_name": "COURTNEY",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "353862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.