Kevin S. Henning, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1089452746 Issued in WA

Practice address

1643 NW 136TH Ave Ste 100
Sunrise, FL 33323-2857

Phone

(509) 868-0876

Fax

(509) 465-9058

NPI assigned

Nov 29, 2006

Last updated

Apr 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Eden Hospice at King County, LLC

  dba Eden Hospice

  • Community Based Hospice Care Agency
  • Tukwila, WA
  • NPI 1255922720

  W-2 Managing Employee

  CMS ownership
• Envision Hospice of Washington LLC

  dba Envision Hospice

  • Community Based Hospice Care Agency
  • Federal Way, WA
  • NPI 1477010940

  Contracted Managing Employee

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1982771606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1643 NW 136TH AVE STE 100",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232857",
            "telephone_number": "509-868-0876",
            "fax_number": "509-465-9058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1643 NW 136TH AVE STE 100",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232857",
            "telephone_number": "509-868-0876",
            "fax_number": "509-465-9058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNING",
        "first_name": "KEVIN",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "1089452746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrena Henderson, RN
• Sokety Heng, PHARMD
• Fernando Agustin Henin, DC
• Tedric Cornelius Henneghan, MD
• Kourtney Hennigan, RN
• Jodi-Ann Shanique Henningham
• Rachel E. Henry Bermudez, AA
• Stephanie S Henry, LCSW, CAP
• Tasha Monique Henry, APRN
• Hanna Katherine Herbert, BS SLP-A

• Family Medicine Physician in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.