Douglas L Hendricks, MD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

G069421 Issued in CA

Practice address

280 Newport Center Dr
Suite 120
Newport Beach, CA 92660-7526

Phone

(949) 640-9570

Fax

(949) 640-9569

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Dr. Douglas L Hendricks Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Pacifica Cosmetic Surgery Center, a Medical Corp

  • Health Service Clinic/Center
  • Newport Beach, CA
  • NPI 1013458975
  NPD (past) Authorized official

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1922165703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 NEWPORT CENTER DR",
            "address_2": "SUITE 120",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607526",
            "telephone_number": "949-640-9570",
            "fax_number": "949-640-9569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 NEWPORT CENTER DR",
            "address_2": "SUITE 120",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607526",
            "telephone_number": "949-640-9570",
            "fax_number": "949-640-9569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7402 E Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "Loves Park",
            "state": "IL",
            "postal_code": "611115630",
            "country_code": "US",
            "telephone_number": "815-971-3920",
            "fax_number": "815-226-9672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "DOUGLAS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "CA",
            "license": "G069421",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036151135",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G069421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922165703",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036151135",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOUGLAS",
            "last_name": "HENDRICKS",
            "middle_name": "L",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Laura Ann Henderson, DPT
• Robyn Henderson
• Serena Henderson
• Deborah Ellen Hendlin, PH.D.
• Steven J. Hendlin, PH.D.
• Karen Hendrickx, P.A.
• Thomas Andrew Hendrickx, MPT,OCS,CSCS
• Pashun Hendrix-Andrus
• Danika Henkel, PT, DPT
• Shannon Leigh Hennigar, L.AC.

• Plastic Surgery Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.