Individual provider Active NPI

Theresa S Henderson, M.D.

  • Pediatrics Physician
  • Avon, IN
National Provider Identifier
1699760645
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01045901A Issued in IN
Practice address
8244 E US Highway 36
Suite 210
Avon, IN 46123-9575
Phone
(317) 272-7337
Fax
(317) 272-8534
NPI assigned
Sep 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01045901A IN Primary

Addresses

Primary practice location

8244 E US Highway 36
Suite 210
Avon, IN 46123-9575

Mailing address

1100 Southfield Dr
Suite 1370
Plainfield, IN 46168-4498
Phone (317) 837-5571

Other identifiers 1

IdentifierTypeStateIssuer
200281970AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address thenderson228580@direct-PRD.stelizabeth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20060601000047 IN Practitioner - Pediatric Medicine 9133130370 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01045901AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hendricks County Hospital Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Hendricks County Hospital Current Accepting new patients
Hendricks County Hospital Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Hendricks County Hospital Past Accepting new patients
Major Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients

Locations

8244 E US Highway 36
Ste 1340
Avon, IN 46123
Phone (317) 520-5510

8244 E US Highway 36
Ste 210
Avon, IN 46123
Phone (317) 272-7337

8244 E US Highway 36
Ste 1100
Avon, IN 46123
Phone (317) 272-7500

1100 Southfield Dr
Ste 1370
Plainfield, IN 46168
Phone (317) 837-5570

Interoperability endpoints

  • FHIR API: https://sehproxy.stelizabeth.com/arr-fhir/api/FHIR/R4

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1699760645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SOUTHFIELD DR",
            "address_2": "SUITE 1370",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461684498",
            "telephone_number": "317-837-5571",
            "fax_number": "317-837-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8244 E US HIGHWAY 36",
            "address_2": "SUITE 210",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239575",
            "telephone_number": "317-272-7337",
            "fax_number": "317-272-8534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "THERESA",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-15",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01045901A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200281970A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thenderson228580@direct-PRD.stelizabeth.com",
            "affiliation": "N",
            "address_1": "8244 E US Highway 36",
            "address_2": "Suite 210",
            "city": "Avon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461239575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Avon, IN

Sources for this page

Verify at the official NPI Registry.