Gary Hendricks, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036.165238 Issued in IL

Practice address

701 N 1St St
Springfield, IL 62781-3757

Phone

(217) 788-3156

NPI assigned

May 7, 2020

Sex

Male

Sole proprietor

No

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

Enrolled in IL

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.

Enrollment records 1

Specialty

Emergency Medicine

Education

Southern Illinois University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Passavant Memorial Area Hospital AssociationGroup PAC ID 3173503281, shared by 2 NPIs, 9 clinicians

Midwest Emergency Department Specialists LTDGroup PAC ID 5193627727, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jacksonville Memorial Hospital Hospital, Jacksonville, IL, CCN 141352
• Memorial Medical Center Hospital, Springfield, IL, CCN 140148

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Midwest Emergency Department Specialists LTD

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1245263367
  Medicare reassignment Care Compare group NPD
• Passavant Memorial Area Hospital Association

  dba Passavant Area Hospital

  • Critical Access Hospital
  • Jacksonville, IL
  • NPI 1174580831
  Medicare reassignment NPD
• Passavant Memorial Area Hospital Association

  dba Passavant Professional Services

  • Internal Medicine Physician
  • Jacksonville, IL
  • NPI 1760994040
  Medicare reassignment NPD
• Passavant Memorial Area Hospital Association

  dba Jacksonville Professional Fees

  • Multi-Specialty Clinic/Center
  • Jacksonville, IL
  • NPI 1235864810
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Medical Center

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1255317590
  Care Compare affiliation
• Passavant Memorial Area Hospital Association

  dba Passavant Area Hospital

  • Critical Access Hospital
  • Jacksonville, IL
  • NPI 1174580831
  Care Compare affiliation

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

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1770105249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19679",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949679",
            "telephone_number": "217-545-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627813757",
            "telephone_number": "217-788-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "GARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-07",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036.165238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtni Henderson-Small
• Ashley Henderson, RN, CDCES
• Donald Wade Henderson, OD
• Lisa L Henderson
• Kieley Angelina Hendricker, RBT
• Jennifer A. Hendricks, FNP-BC
• Laura Hendricks
• Sean David Hendricks, M.D.
• Laura Henehan, MS, CCC-SLP
• Shady Henien, M.D.

• Emergency Medicine Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.