NPIMap

Individual provider Active NPI

Chris Henderson, MD

  • Family Medicine Physician
  • Grand Forks, ND
National Provider Identifier
1669766283
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12463 Issued in ND
Practice address
1380 S Columbia Rd
Grand Forks, ND 58201-4059
Phone
(701) 795-2000
Fax
(701) 795-2260
NPI assigned
May 31, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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 12463 ND Primary

Addresses

Primary practice location

1380 S Columbia Rd
Grand Forks, ND 58201-4059

Mailing address

725 Hamline St
Grand Forks, ND 58203-2819
Phone (701) 795-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address chenderson29091@direct.directaltru.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130828000931 ND Practitioner - Family Practice 3971746611 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12463NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System CurrentSince Aug 1, 2013 Accepting new patients
Altru Health System CurrentSince Aug 1, 2013 Accepting new patients
Altru Health System Family Medicine Current Accepting new patients
4000 Valley Square Inc Past Accepting new patients
Valley Homes and Services Past Accepting new patients

Locations

201 E 3rd Ave S
Cavalier, ND 58220
Phone (701) 265-8338

301 Mountain St E
Ste A
Cavalier, ND 58220
Phone (701) 265-4196

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

1200 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5243

960 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5400

725 Hamline St
Grand Forks, ND 58203
Phone (701) 777-6800

2900 14th Ave S
Grand Forks, ND 58201
Phone (701) 741-1979

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Valley Senior Living on ColumbiaGrand Forks, ND, CCN 355067 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 25, 2018
Jun 25, 2018
Woodside VillageGrand Forks, ND, CCN 355112 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 25, 2018
Jun 25, 2018

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health System 675 clinicians

Practice addresses (Care Compare)

960 S Columbia Rd
Grand Forks, ND 58201-4030
Phone (701) 780-5400

Hospital & facility affiliations

  • Hia Hospice Hospice, Fargo, ND, CCN 351500
  • Ethos Hospice Hospice, Fargo, ND, CCN 351517
  • Altru Hospital Hospital, Grand Forks, ND, CCN 350019
  • Valley Senior Living on Columbia Nursing home, Grand Forks, ND, CCN 355067
  • Woodside Village Nursing home, Grand Forks, ND, CCN 355112

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

NPI Registry JSON

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

{
    "created_epoch": "1306800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1669766283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 HAMLINE ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582032819",
            "telephone_number": "701-795-2000",
            "fax_number": "701-795-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014059",
            "telephone_number": "701-795-2000",
            "fax_number": "701-795-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "CHRIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-31",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "12463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chenderson29091@direct.directaltru.org",
            "affiliation": "N",
            "endpointDescription": "Direct mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1380 S Columbia Rd",
            "city": "Grand Forks",
            "state": "ND",
            "country_code": "US",
            "postal_code": "582014059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.