Active NPI
Glenna P. Hendricks, M.D.
- Family Medicine Physician
- Midlothian, VA
National Provider Identifier
1952333130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101229281
- Practice address
- 13540 Hull Street Rd
Midlothian, VA 23112-2107 - Phone
- (804) 739-6142
- Fax
- (804) 739-8923
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101229281 | VA | Primary |
| Obstetrics & Gynecology Physician | 207V00000X | 0101229281 | VA |
Addresses
Primary practice location
13540 Hull Street Rd
Midlothian, VA 23112-2107
Mailing address
13540 Hull Street Rd
Midlothian, VA 23112-2107
Phone (804) 739-6142
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010185475 | Medicaid | VA | |
| 1001128 | Other | VA | SENTARA |
| 321012 | Other | VA | SOUTHERN HEALTH SERVICES |
| 3962989 | Other | VA | AETNA HMO |
| 4892804 | Other | VA | CIGNA |
| 5348291 | Other | VA | CIGNA |
| 7765699 | Other | VA | AETNA LIFE |
| 182433 | Other | VA | ANTHEM BCBS OF VA |
| 2138657 | Other | VA | MAMSI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050829000758 | VA | Practitioner - Family Practice | 6204867310 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101229281 | VA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304035200000",
"number": "1952333130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13540 HULL STREET RD",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231122107",
"telephone_number": "804-739-6142",
"fax_number": "804-739-8923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13540 HULL STREET RD",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231122107",
"telephone_number": "804-739-6142",
"fax_number": "804-739-8923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKS",
"first_name": "GLENNA",
"middle_name": "P.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2011-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101229281",
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "VA",
"license": "0101229281",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010185475",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SENTARA",
"identifier": "1001128",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH SERVICES",
"identifier": "321012",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "3962989",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "4892804",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5348291",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA LIFE",
"identifier": "7765699",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS OF VA",
"identifier": "182433",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "2138657",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Midlothian, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; 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.