Raquel Marie Henderson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

850 W Highland Ave Ste a
San Bernardino, CA 92405-3855

Phone

(909) 886-7576

NPI assigned

Jul 27, 2006

Sex

Female

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 CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: raquel.henderson.1@12477.direct.athenahealth.com

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.

• Christopher Kassar D.O. Inc.

  • Family Medicine Physician
  • San Dimas, CA
  • NPI 1831346592
  Medicare reassignment

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1770597809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W HIGHLAND AVE STE A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053855",
            "telephone_number": "909-886-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W HIGHLAND AVE STE A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053855",
            "telephone_number": "909-886-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "RAQUEL",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darlene Henderson
• Jasmine Henderson
• Kiera A Henderson
• Letitia Henderson
• Matthew Lee Henderson
• Shakoya Henderson
• Shatzie V Henderson
• Celine Hendricks
• Starla Elizabeth Hendrix
• Madison Henery

• Medical Physician Assistant in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.