NPIMap

Individual provider Active NPI

Michael A Henderson, DO

  • Diagnostic Radiology Physician
  • Grand Rapids, MI
National Provider Identifier
1699731299
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
5101009653 Issued in MI
Practice address
3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 363-7339
Fax
(616) 361-5828
NPI assigned
Apr 22, 2006
Last updated
Sep 12, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5101009653 MI Primary

Addresses

Primary practice location

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Mailing address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone (616) 363-7339

Other identifiers 1

IdentifierTypeStateIssuer
4738550MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20050124000713 MI Practitioner - Diagnostic Radiology 6305896879 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Michigan State University College of Osteopathic Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 363-7272

900 E Sherwood Rd
Williamston, MI 48895-9328
Phone (616) 363-7272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.17 of 100Reported as group
Quality
91.34
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101009653MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Radiology Services PC Diagnostic Radiology CurrentSince Sep 1, 2018 Accepting new patients
Breast Center of Lansing PLLC Past Accepting new patients
Michigan Radiology Consultants, PC Diagnostic Radiology PastSince Nov 17, 1994 Accepting new patients
Kellam & Associates, P. C. Diagnostic Radiology Past Accepting new patients
Mercy Hospital Grayling Past Accepting new patients

Locations

420 W High St
Dowagiac, MI 49047
Phone (269) 782-8681

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

3264 N Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 391-6001

844 Washington Ave
Holland, MI 49423
Phone (616) 355-3874

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1699731299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7339",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7339",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-22",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101009653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4738550",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.