NPIMap

Individual provider Active NPI

Bradley Henningsgaard, PA-C

  • Physician Assistant
  • Durham, NC
National Provider Identifier
1669877387
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06919 Issued in NC
Practice address
2301 Erwin Rd Department of Radiology
Durham, NC 27710-1645
Phone
(919) 684-7284
Fax
(919) 613-2680
NPI assigned
Oct 23, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06919 NC Primary

Addresses

Primary practice location

2301 Erwin Rd Department of Radiology
Durham, NC 27710-1645

Mailing address

5345 Silver Moon LN
Raleigh, NC 27606-4534
Phone (512) 426-1814

Other practice location 1

566 Ruin Creek Rd
Henderson, NC 27536-2927
Phone (252) 436-1164

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141224000005 VA Practitioner - Physician Assistant 0446573430 Reassigns benefits to 1 organization
I20170502001833 NC Practitioner - Physician Assistant 0446573430 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111

Hospital & facility affiliations

  • Duke University Hospital Hospital, Durham, NC, CCN 340030
  • Duke Regional Hospital Hospital, Durham, NC, CCN 340155

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06919NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dominion Health Medical Assoc CurrentSince Dec 1, 2014 Accepting new patients
Duke Health Integrated Practice, Inc CurrentSince Jul 1, 2023 Accepting new patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients

Locations

2100 Erwin Rd
Durham, NC 27705
Phone (919) 648-8111

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

2204 Wilborn Ave
South Boston, VA 24592
Phone (434) 517-3100

2232 Wilborn Ave
Ste F
South Boston, VA 24592
Phone (434) 517-8095

Interoperability endpoints

  • Direct secure messaging: bhenningsgaard176656@direct.medicine.duke.edu

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1669877387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5345 SILVER MOON LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276064534",
            "telephone_number": "512-426-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD DEPARTMENT OF RADIOLOGY",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277101645",
            "telephone_number": "919-684-7284",
            "fax_number": "919-613-2680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "566 Ruin Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NC",
            "postal_code": "275362927",
            "country_code": "US",
            "telephone_number": "252-436-1164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNINGSGAARD",
        "first_name": "BRADLEY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-23",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.