NPIMap

Organization Active NPI

Gregory L Henderson MD Facs Inc

  • Ophthalmology Physician
  • Sun City Center, FL
National Provider Identifier
1821082249
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
GREGORY L HENDERSON MD FACS INC
Practice address
1701 Rickenbacker Dr.
Ste 102
Sun City Center, FL 33573-5361
Phone
(813) 634-7788
Fax
(813) 634-2266
NPI assigned
Aug 31, 2005
Organization subpart
Yes
Parent organization
GREGORY L HENDERSON MD FACS INCAs reported in NPPES

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

Authorized official

Name
Mr. Gregory L Henderson Sr., MD
Title
President
Phone
(813) 681-1122

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1701 Rickenbacker Dr.
Ste 102
Sun City Center, FL 33573-5361

Mailing address

403 Vonderburg Dr
Brandon, FL 33511-5982
Phone (813) 681-1122

Other identifiers 2

IdentifierTypeStateIssuer
060983802MedicaidFL
0609838-02MedicaidFL

Other names 1

  • Florida Eye Specialists and Cataract Institute Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040722001097 FL Part B Supplier - Clinic/Group Practice 9739172321 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverview, FL; Tampa, FL; Sun City Center, FL; Ruskin, FL; Plant City, FL; Lake Wales, FL; Brandon, FL

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2321006Gregory L Henderson, MD, Facs, Inc1701 Rickenbacker Dr, Sun City Center, FL 33573Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Part of
Gregory L Henderson MD Facs

Locations

612 N US Highway 41
Ruskin, FL 33570
Phone (813) 645-3831

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1821082249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 VONDERBURG DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115982",
            "telephone_number": "813-681-1122",
            "fax_number": "813-684-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 RICKENBACKER DR.",
            "address_2": "STE 102",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335735361",
            "telephone_number": "813-634-7788",
            "fax_number": "813-634-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY L HENDERSON MD FACS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREGORY L HENDERSON MD FACS INC",
        "enumeration_date": "2005-08-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-681-1122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060983802",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0609838-02",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Eye Specialists and Cataract Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sun City Center, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.