Ed Jerald Hendricks, M.D.

Primary specialty

Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X

License

G22146 Issued in CA

Practice address

2510 Douglas Blvd
Suite 200
Roseville, CA 95661-3300

Phone

(916) 773-1191

Fax

(916) 773-0498

NPI assigned

Apr 17, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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 Jun 18, 2013 through Jun 18, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366156800000",
    "number": "1700220092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 DOUGLAS BLVD",
            "address_2": "SUITE 200",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613300",
            "telephone_number": "916-773-1191",
            "fax_number": "916-773-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 DOUGLAS BLVD",
            "address_2": "SUITE 200",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613300",
            "telephone_number": "916-773-1191",
            "fax_number": "916-773-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "ED",
        "middle_name": "JERALD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2013-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "CA",
            "license": "G22146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen M. Hendershott, MD
• Gary Lynn Henderson, MFT
• Gregory Henderson
• Lorre T Henderson, MD
• Hendricks Medical Corporation
• Lynn Michele Hendrickson-Andres, MS, CCC-SLP
• Jay A Hendrickson, M.D.
• Artur Z. Henke, MD
• Betsy Hennessy, RD,CSR
• Samuel Henning

• Obesity Medicine (Internal Medicine) Physician in Roseville, CA
• Providers in Roseville, CA by specialty
• Obesity Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.