Active NPI
Michael Conley Hendren, MD
- Family Medicine Physician
- Russellville, AR
National Provider Identifier
1679539928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C-5062
- Practice address
- 404 N El Paso Ave
Russellville, AR 72801-3737 - Phone
- (479) 968-4177
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C-5062 | AR | Primary |
Addresses
Primary practice location
404 N El Paso Ave
Russellville, AR 72801-3737
Mailing address
30 Burton Hills Blvd
Ste 175
Nashville, TN 37215-6403
Phone (615) 988-2014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101738001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-5062 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Marys Physician Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Interventional Cardiology Physician
- Russellville, AR
- NPI 1720356207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1679539928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 BURTON HILLS BLVD",
"address_2": "STE 175",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372156403",
"telephone_number": "615-988-2014",
"fax_number": "615-523-0647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 N EL PASO AVE",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728013737",
"telephone_number": "479-968-4177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDREN",
"first_name": "MICHAEL",
"middle_name": "CONLEY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AR",
"license": "C-5062",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101738001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.