NPIMap

Individual provider Active NPI

Mark E Henderson, DO

  • Family Medicine Physician
  • Lincoln, NE
National Provider Identifier
1760902498
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TEP8073 Issued in NE
Practice address
4600 Valley Rd Ste 200
Lincoln, NE 68510-4882
Phone
(402) 483-4571
Fax
(402) 483-5633
NPI assigned
Jun 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 TEP8073 NE Primary

Addresses

Primary practice location

4600 Valley Rd Ste 200
Lincoln, NE 68510-4882

Mailing address

4600 Valley Rd Ste 200
Lincoln, NE 68510-4882
Phone (402) 483-4571

Other identifiers 1

IdentifierTypeStateIssuer
470553011-00MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20200825000485 UT Practitioner - Family Practice 3072888239 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Utah Medical GroupGroup PAC ID 2961496609, 52 clinicians

Practice addresses (Care Compare)

405 N 500
Vernal, UT 84078-1907
Phone (435) 789-6203

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.32 of 100Reported as apm
Quality
71.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TEP8073NEMDFamily Medicine Physician
1885NEMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ashley Valley Physician Practice, LLC CurrentSince Aug 1, 2020 Accepting new patients
Ashley Valley Physician Practice LLC CurrentSince Aug 1, 2020 Accepting new patients
Northeastern Utah Medical Group Family Medicine CurrentSince Jan 1, 2024 Accepting new patients
Uintah Basin Medical Center CurrentSince Jan 1, 2024 Accepting new patients
Northeastern Utah Medical Group CurrentSince Jan 1, 2024 Accepting new patients
Ashley Valley Physician Practice, LLC Family Medicine Current Accepting new patients
Uintah Basin Medical Center CurrentSince Jan 1, 2024 Accepting new patients

Locations

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426

210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

150 W 100 N
Ste S103
Vernal, UT 84078
Phone (435) 781-1011

175 N 100 W
Ste 104
Vernal, UT 84078
Phone (435) 781-3053

405 N 500 W
Vernal, UT 84078
Phone (435) 781-2335

150 W 100 N
Vernal, UT 84078
Phone (435) 789-3342

Interoperability endpoints

  • Direct secure messaging: fob6517@yourcarecommunity.org

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.

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": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1760902498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 VALLEY RD STE 200",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685104882",
            "telephone_number": "402-483-4571",
            "fax_number": "402-483-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 VALLEY RD STE 200",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685104882",
            "telephone_number": "402-483-4571",
            "fax_number": "402-483-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "TEP8073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470553011-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.