NPIMap

Individual provider Active NPI

Cassidy H Prentice, PAC

  • Physician Assistant
  • Zebulon, NC
National Provider Identifier
1689009169
Registry record updated Apr 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-04382 Issued in NC
Practice address
903 N Arendell Ave
Zebulon, NC 27597-2307
Phone
(919) 404-0445
Fax
(919) 404-1642
NPI assigned
Sep 4, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2014

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 0010-04382 NC Primary

Addresses

Primary practice location

903 N Arendell Ave
Zebulon, NC 27597-2307

Mailing address

PO Box 7867
Rocky Mount, NC 27804-0867
Phone (252) 451-2700

Other identifiers 1

IdentifierTypeStateIssuer
1689009169MedicaidNC

Other names 1

  • Cassidy Henneman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160718000348 CO Practitioner - Physician Assistant 1759516446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

221 E 29TH St
Loveland, CO 80538-2746

2964 Ginnala Dr
Loveland, CO 80538-2701
Phone (970) 667-7755

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

730 14TH St SW
Loveland, CO 80537-6349
Phone (970) 663-0815

8890 N Union Blvd
Suite 170 Uchmg Primary Care Briargate
Colorado Springs, CO 80920-2701
Phone (719) 364-5005

Hospital & facility affiliations

  • Accentcare Home Health of Mountain Valley LLC Home health agency, Denver, CO, CCN 067445
  • Bayada Home Health Care Inc Home health agency, Loveland, CO, CCN 067506
  • Centerwell Home Health Home health agency, Colorado Springs, CO, CCN 067129
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
  • Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
  • Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
  • Longs Peak Hospital Hospital, Longmont, CO, CCN 060128

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-04382NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Aug 29, 2016 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Aug 29, 2016 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

221 E 29th St
Ste 202
Loveland, CO 80538
Phone (970) 203-7050

2500 Rocky Mountain Ave
Ste 2200
Loveland, CO 80538
Phone (970) 203-7250

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

221 E 29th St
Ste 102
Loveland, CO 80538
Phone (970) 224-3636

Organizations & group practices 2

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398384000000",
    "number": "1689009169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7867",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278040867",
            "telephone_number": "252-451-2700",
            "fax_number": "252-451-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 N ARENDELL AVE",
            "city": "ZEBULON",
            "state": "NC",
            "postal_code": "275972307",
            "telephone_number": "919-404-0445",
            "fax_number": "919-404-1642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "CASSIDY",
        "middle_name": "H",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2014-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689009169",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASSIDY",
            "last_name": "HENNEMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Zebulon, NC

Sources for this page

Verify at the official NPI Registry.