NPIMap

Individual provider Active NPI

David A Henderson, M.D.

  • Cardiovascular Disease Physician
  • Daytona Beach, FL
National Provider Identifier
1750332250
Registry record updated Dec 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME0038731 Issued in FL
Practice address
305 Memorial Medical Pkwy
Suite 301
Daytona Beach, FL 32117-5168
Phone
(386) 677-5351
Fax
(386) 673-2787
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME0038731 FL Primary

Addresses

Primary practice location

305 Memorial Medical Pkwy
Suite 301
Daytona Beach, FL 32117-5168

Mailing address

305 Memorial Medical Pkwy
Suite 301
Daytona Beach, FL 32117-5168
Phone (386) 677-5351

Other identifiers 1

IdentifierTypeStateIssuer
043002100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20070824000148 FL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0648216168 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
West Virginia University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiology Physicians Memorial, LLCGroup PAC ID 2567622954, 13 clinicians

Practice addresses (Care Compare)

103 Memorial Medical Pkwy
Suite 200
Daytona Beach, FL 32117-5121
Phone (386) 615-1521

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.22 of 100Reported as group
Quality
94.03
Promoting interoperability
97
Improvement activities
40
Cost
75.88

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0038731FLMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiology Physicians Memorial, LLC Cardiovascular Disease CurrentSince Mar 1, 2012 Accepting new patients
Cardiology Physicians, P.a. CurrentSince Aug 25, 1981 Accepting new patients
Halifax Healthcare Systems Inc CurrentSince Jun 1, 2007 Accepting new patients
Cardiology Physicians PA CurrentSince Aug 25, 1981 Accepting new patients

Locations

103 Memorial Medical Pkwy
Ste 200
Daytona Beach, FL 32117
Phone (386) 615-1521

305 Memorial Medical Pkwy
Ste 301
Daytona Beach, FL 32117
Phone (386) 231-4450

400 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 239-5000

311 N Clyde Morris Blvd
Ste 320
Daytona Beach, FL 32114
Phone (386) 255-5331

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

Use Ci1660
Orlando, FL 32886

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18215/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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 6

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323129600000",
    "number": "1750332250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 MEMORIAL MEDICAL PKWY",
            "address_2": "SUITE 301",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175168",
            "telephone_number": "386-677-5351",
            "fax_number": "386-673-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 MEMORIAL MEDICAL PKWY",
            "address_2": "SUITE 301",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175168",
            "telephone_number": "386-677-5351",
            "fax_number": "386-673-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DAVID",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2011-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME0038731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043002100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.