Michael Henderson, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05008295A Issued in IN

Practice address

1005 N Hickory Rd
South Bend, IN 46615-3723

Phone

(574) 233-5754

Fax

(574) 233-7406

NPI assigned

Sep 29, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beacon Health LLCGroup PAC ID 1254690530, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Beacon Health, LLC

  • Physical Therapist
  • Granger, IN
  • NPI 1386154821
  Medicare reassignment Care Compare group NPD
• McDonald Physical Therapy

  • Clinic/Center
  • South Bend, IN
  • NPI 1063419026

  Physical Therapist

  Medicare reassignment NPD
• Beacon Health, LLC

  • Diagnostic Radiology Physician
  • Goshen, IN
  • NPI 1952982217
  NPD (past)
• Beacon Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • South Bend, IN
  • NPI 1831149525
  NPD (past)
• McDonald Physical Therapy and Sports Rehabilitation Center

  • Physical Therapy Assistant
  • South Bend, IN
  • NPI 1710863691
  NPD (past)

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659463354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14463 THELMA CT",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308460",
            "telephone_number": "574-271-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 N HICKORY RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466153723",
            "telephone_number": "574-233-5754",
            "fax_number": "574-233-7406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05008295A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000356942",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Rena Hempstead, FNP
• Aaron James Henderson
• Alberta Lee Henderson, M.D.
• Jamie Lynn Henderson, PMHNP
• Malaysia Henderson, RBT
• Susan K Henderson, LAC
• Taryll Henderson, LCSW
• Victor Henderson
• Vincent Charles Henderson, M.D.
• Rebecca McFadden Hendricks, MD

• Physical Therapist in South Bend, IN
• Providers in South Bend, IN by specialty
• Physical Therapist in Indiana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.