Kevin Hendrickson

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0101282168 Issued in VA

Practice address

11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603

Phone

(908) 255-2087

NPI assigned

Aug 24, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Temple University School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Medical Associates New York PCGroup PAC ID 7618310368, 100 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S Hospital Health Center Hospital, Syracuse, NY, CCN 330140
• Gouverneur Hospital Hospital, Gouverneur, NY, CCN 331315

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Physicians Medical Associates New York PC

  • Emergency Medicine Physician
  • Syracuse, NY
  • NPI 1073386421
  Medicare reassignment Care Compare group NPD
• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782
  Medicare reassignment NPD
• Gouverneur Hospital

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1295156412
  Medicare reassignment NPD
• Massena Hospital Inc

  • Critical Access Hospital
  • Massena, NY
  • NPI 1972604460
  Medicare reassignment NPD
• Canton-Potsdam Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Potsdam, NY
  • NPI 1114104445
  NPD
• Gouverneur Hospital

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1629409925
  NPD
• Massena Hospital, Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Massena, NY
  • NPI 1619756640
  NPD
• Physicians Medical Associates New York PC

  • Emergency Medicine Physician
  • Poughkeepsie, NY
  • NPI 1487409702
  NPD

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

• Gouverneur Hospital

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1629409925
  Care Compare affiliation
• St Josephs Hospital Health Center

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1508815333
  Care Compare affiliation

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

{
    "created_epoch": "1408838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1689074957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 KNICKERBOCKER DR",
            "city": "BELLE MEAD",
            "state": "NJ",
            "postal_code": "085024545",
            "telephone_number": "908-255-2087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136022603",
            "telephone_number": "908-255-2087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "KEVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-24",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101282168",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "339422",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Glen Hart, PA-C
• Sarah D Hasko, MSN, FNP-C
• John Hauck, PA-C
• Jessica Parker Hayden, PHYSICIAN ASSISTANT
• Helping Hands Concierge, LLC
• Shondra Henry, LCSW
• Ara Alessys Herrera
• Shannon Hickey, LCSW
• Joshua Lee Hickman, PA-C
• Amanda Highers

• Emergency Medicine Physician in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.