Active NPI
Emily Ann Hendrickson
- General Practice Physician
- Camp Pendleton, CA
National Provider Identifier
1679219794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0101279637
- Practice address
- 200 Mercy Circle
Camp Pendleton, CA 92055-5191 - Phone
- (760) 725-4357
- NPI assigned
- May 11, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | |||
| General Practice Physician | 208D00000X | 0101279637 | VA | Primary |
Addresses
Primary practice location
200 Mercy Circle
Camp Pendleton, CA 92055-5191
Mailing address
200 Mercy Circle
Camp Pendleton, CA 92055-5191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250128001323 | VA | Order and Referring Only - Family Practice | 0345779930 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725148800000",
"number": "1679219794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "920555191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "920555191",
"telephone_number": "760-725-4357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKSON",
"first_name": "EMILY",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-11",
"last_updated": "2024-09-01",
"certification_date": "2024-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0101279637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Camp Pendleton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.