Individual provider Active NPI

Aphrodite M Henderson, M.D.

  • Surgery Physician
  • Hannibal, MO
National Provider Identifier
1861471450
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2000155784 Issued in MO
Practice address
100 Medical Dr
Hannibal, MO 63401-6877
Phone
(573) 231-3161
Fax
(573) 221-4185
NPI assigned
Jan 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2000155784 MO Primary

Addresses

Primary practice location

100 Medical Dr
Hannibal, MO 63401-6877

Mailing address

100 Medical Dr
P.O. Box 311
Hannibal, MO 63401-6877
Phone (573) 231-3161

Other identifiers 1

IdentifierTypeStateIssuer
204957401MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address AHenderson@hannibalclinic.directbygreenway.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100116000133 MO Practitioner - General Surgery 0547302366 Reassigns benefits to 1 organization
I20170717000414 IL Practitioner - General Surgery 0547302366 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Pennsylvania, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blessing HospitalGroup PAC ID 3072422534, 414 clinicians

Practice addresses (Care Compare)

100 Medical Dr
Hannibal, MO 63401-6877
Phone (217) 223-8400

927 Broadway St
Quincy, IL 62301-2719
Phone (217) 224-6423

Hospital & facility affiliations

  • Blessing Hospital Hospital, Quincy, IL, CCN 140015
  • Hannibal Regional Hospital Hospital, Hannibal, MO, CCN 260025

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy38
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux14
Varicose vein removal1-10
Melanoma (skin cancer) excision19
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McDonough County Hospital District CurrentSince May 14, 2021 Accepting new patients
Blessing Hospital CurrentSince May 1, 2022 Accepting new patients
Blessing Hospital CurrentSince May 1, 2022 Accepting new patients
McDonough County Hospital District CurrentSince May 14, 2021 Accepting new patients
Blessing Hospital Past Accepting new patients

Locations

525 E Grant St
Macomb, IL 61455
Phone (309) 836-1611

503 E Grant St
Macomb, IL 61455
Phone (309) 833-5917

1005 Broadway St
Quincy, IL 62301

100 Medical Dr
Hannibal, MO 63401

101 Medical Dr
Hannibal, MO 63401

103 E Commercial St
Kahoka, MO 63445
Phone (660) 727-3377

Interoperability endpoints

  • Direct secure messaging: ahenderson@hannibalclinic.directbygreenway.com
  • FHIR API: https://fhir.blessinghospital.com/R4/open-Prod

Organizations & group practices 5

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 3

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1861471450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL DR",
            "address_2": "P.O. BOX 311",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016877",
            "telephone_number": "573-231-3161",
            "fax_number": "573-221-4185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016877",
            "telephone_number": "573-231-3161",
            "fax_number": "573-221-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "APHRODITE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-11",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2000155784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204957401",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "AHenderson@hannibalclinic.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Medical Dr",
            "city": "Hannibal",
            "state": "MO",
            "country_code": "US",
            "postal_code": "634016877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

Verify at the official NPI Registry.