Derek Henderson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1680 Issued in NH

Practice address

3726 Broadway Ste 201
Everett, WA 98201-3788

Phone

(425) 317-9119

NPI assigned

Dec 22, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kittitas County Public Hospital Dist 1Group PAC ID 0547179608, shared by 7 NPIs, 82 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kittitas Valley Community Hospital Hospital, Ellensburg, WA, CCN 501333

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Kittitas County Public Hospital Dist 1

  • Critical Access Hospital
  • Ellensburg, WA
  • NPI 1356375307
  Medicare reassignment
• Western Washington Medical Group, Inc PS

  • Psychiatry Physician
  • Everett, WA
  • NPI 1396413803
  Medicare reassignment
• Kittitas County Public Hosp Dist 1

  • Urology Physician
  • Ellensburg, WA
  • NPI 1437029832
  NPD
• Western Washington Medical Group, Inc PS

  • Orthopaedic Surgery Physician
  • Everett, WA
  • NPI 1376761775
  NPD
• Western Washington Medical Group, Inc PS

  • Infectious Disease Physician
  • Everett, WA
  • NPI 1427816305
  NPD
• Kittitas County Public Hospital Dist 1

  • Rural Health Clinic/Center
  • Ellensburg, WA
  • NPI 1932115391
  NPD (past)

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

• Kittitas County Public Hospital Dist 1

  • Critical Access Hospital
  • Ellensburg, WA
  • NPI 1356375307
  Care Compare affiliation

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

{
    "created_epoch": "1482364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1871038109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 BROADWAY STE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013788",
            "telephone_number": "425-317-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 BROADWAY STE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013788",
            "telephone_number": "425-317-9119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 13th St",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982011689",
            "country_code": "US",
            "telephone_number": "425-261-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14989 Harvest Rd",
            "address_purpose": "LOCATION",
            "city": "Glencoe",
            "state": "MN",
            "postal_code": "553367505",
            "country_code": "US",
            "telephone_number": "320-293-9466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DEREK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-22",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1680",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helping Hands Project Organization
• Jennifer D Heming, D.M.D.
• Christopher Robert Hempel, MD
• Delores Henderson Henderson Steele
• Daniel Henderson, AACR
• Eason Henderson, M.C.
• Kathryn Grace Crisman Henderson, MA, AAC-L,MHP
• Kevin Henderson
• Kristin Emily Henderson, MA, AAC-R
• Philip E. Henderson, MD

• Physician Assistant in Everett, WA
• Providers in Everett, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; 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.