NPIMap

Individual provider Active NPI

Jeffrey Donaldson Henderer, MD

  • Ophthalmology Physician
  • Philadelphia, PA
National Provider Identifier
1730173410
Registry record updated Mar 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD065345L Issued in PA
Practice address
3401 N Broad St
6TH Floor, Parkinson Pavilion
Philadelphia, PA 19140-5103
Phone
(215) 707-3185
Fax
(215) 707-1684
NPI assigned
Sep 8, 2005
Last updated
Mar 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD065345L PA Primary

Addresses

Primary practice location

3401 N Broad St
6TH Floor, Parkinson Pavilion
Philadelphia, PA 19140-5103

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-3185

Other identifiers 1

IdentifierTypeStateIssuer
0017739950005MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040803000989 DE Practitioner - Ophthalmology 5092786129 Reassigns benefits to 1 organization
I20080709000410 PA Practitioner - OphthalmologyPractitioner - Other (Physician) 5092786129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Johns Hopkins University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-5030

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD065345LPAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc Ophthalmology CurrentSince Jan 17, 2005 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 10, 2019 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 10, 2019 Accepting new patients
Christiana Care Health Services, Inc Current Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Christiana Care Health Services Inc CurrentSince Jan 17, 2005 Accepting new patients
Ophthalmic Partners of New Jersey, PC Ophthalmology Past Accepting new patients
Ophthalmic Partners of Delaware, PA Ophthalmology Past Accepting new patients
Delaware Eye Care Center PA Ophthalmology Past Accepting new patients

Locations

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

501 W 14th St
Wilmington, DE 19801
Phone (302) 320-4411

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3401 N Broad St
Fl 6
Philadelphia, PA 19140
Phone (215) 707-3185

7500 Central Ave
Philadelphia, PA 19111
Phone (215) 214-4100

Organizations & group practices 9

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 9

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1730173410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3185",
            "fax_number": "215-707-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "address_2": "6TH FLOOR, PARKINSON PAVILION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-3185",
            "fax_number": "215-707-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERER",
        "first_name": "JEFFREY",
        "middle_name": "DONALDSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD065345L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017739950005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.