Individual provider Active NPI

Douglas E Henry, MD

  • Pediatric Rehabilitation Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1639116122
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X
License
4301054794 Issued in MI
Practice address
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone
(616) 840-8005
Fax
(616) 840-9642
NPI assigned
Jun 1, 2006
Last updated
Apr 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Rehabilitation Medicine Physician 2081P0010X 4301054794 MI Primary
Pediatric Rehabilitation Medicine Physician 2081P0010X 35072544 OH

Addresses

Primary practice location

235 Wealthy St SE
Grand Rapids, MI 49503-5247

Mailing address

235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 840-8877

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dhenry90239@direct.covenanthealthcare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051208000529 MI Practitioner - Physical Medicine and RehabilitationPractitioner - Pediatric Medicine 7012972318 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Pediatric Medicine
Education
Wayne State University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 242-0422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Free Bed Rehabilitation Hospital Physical Medicine & Rehabilitation CurrentSince Aug 21, 2019 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 1, 2021 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 1, 2021 Accepting new patients
Mary Free Bed Rehabilitation Hospital CurrentSince Aug 21, 2019 Accepting new patients

Locations

235 Wealthy St SE
Grand Rapids, MI 49503
Phone (616) 242-0422

35 Michigan St NE
Ste 3003
Grand Rapids, MI 49503
Phone (616) 267-2200

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1639116122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8877",
            "fax_number": "616-840-9690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8005",
            "fax_number": "616-840-9642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "DOUGLAS",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "MI",
            "license": "4301054794",
            "primary": true
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "OH",
            "license": "35072544",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dhenry90239@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "235 Wealthy St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495035247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.