Mark Hamilton Henigan, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

20A6351 Issued in CA

Practice address

1729 Tully Rd
Suite Eight
Modesto, CA 95350-4082

Phone

(209) 544-8363

Fax

(209) 758-0995

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1689897365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1729 TULLY RD",
            "address_2": "SUITE EIGHT",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504082",
            "telephone_number": "209-544-8363",
            "fax_number": "209-758-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 TULLY RD",
            "address_2": "SUITE EIGHT",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504082",
            "telephone_number": "209-544-8363",
            "fax_number": "209-758-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENIGAN",
        "first_name": "MARK",
        "middle_name": "HAMILTON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A6351",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "20A6351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9519325",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachael Hendricks
• Katherine Marie Hendrickson, AMFT
• James Lee Hendrix, MA:MFT
• Hillary Gayle Hendryk, M.D.
• Chamroeun Heng, M.D.
• June Miyoko Henley-Meyer I
• James Oral Henman, PH.D.
• Sonia Maria Henman, M.S.
• Annie Thu Henrich
• Nicole Henriques

• Psychiatry Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.