NPIMap

Individual provider Active NPI

Randall Dale Henderson, DO

  • Family Medicine Physician
  • Whitney, TX
National Provider Identifier
1700879848
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L1340 Issued in TX
Practice address
1314 N Brazos St
Whitney, TX 76692-2010
Phone
(254) 694-3621
Fax
(254) 694-7436
NPI assigned
Aug 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L1340 TX Primary

Addresses

Primary practice location

1314 N Brazos St
Whitney, TX 76692-2010

Mailing address

PO Box 2177
Whitney, TX 76692-5177
Phone (254) 694-3621

Other identifiers 1

IdentifierTypeStateIssuer
159121604MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20110308001010 TX Practitioner - Family Practice 4486645215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Randall Henderson, D.O. PLLCGroup PAC ID 3274759303, 6 clinicians

Practice addresses (Care Compare)

1314 N Brazos St
Whitney, TX 76692-2010
Phone (254) 694-3621

Hospital & facility affiliations

  • Paradigm Home Health Home health agency, Whitney, TX, CCN 747950
  • Accentcare Home Health of Waco Home health agency, Waco, TX, CCN 679200
  • Lee Healthcare Inc Home health agency, Hamilton, TX, CCN 677412
  • Enhabit Home Health Home health agency, Fort Worth, TX, CCN 679167
  • Restoring Function HHC LLC Home health agency, Burleson, TX, CCN 747775
  • Wings Over Texas Hospice Hospice, Cleburne, TX, CCN 971524
  • Ascension Providence Hospital, Waco, TX, CCN 450042
  • Texas Health Harris Methodist Hospital Cleburne Hospital, Cleburne, TX, CCN 450148
  • Hill Regional Hospital Hospital, Hillsboro, TX, CCN 451395
  • Whitney Nursing and Rehabilitation Center Nursing home, Whitney, TX, CCN 676074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L1340TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Randall Henderson, D.O. PLLC Family Medicine CurrentSince Mar 18, 2014 Accepting new patients
Town Hall Estates-Whitney Inc. Past Accepting new patients
Nocona Hospital District Past Accepting new patients

Locations

1314 N Brazos St
Whitney, TX 76692
Phone (254) 694-3621

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Whitney Family MedicineWhitney, TX, CCN 673933 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer
Operational/Managerial Control		 Mar 18, 2014
Mar 18, 2014
Mar 18, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 10

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": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1700879848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2177",
            "city": "WHITNEY",
            "state": "TX",
            "postal_code": "766925177",
            "telephone_number": "254-694-3621",
            "fax_number": "254-694-7436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 N BRAZOS ST",
            "city": "WHITNEY",
            "state": "TX",
            "postal_code": "766922010",
            "telephone_number": "254-694-3621",
            "fax_number": "254-694-7436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "RANDALL",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L1340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159121604",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitney, TX

Sources for this page

Verify at the official NPI Registry.