Active NPI
Derek Henningsen
- Exclusive Provider Organization
- Debary, FL
National Provider Identifier
1992153209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exclusive Provider Organization
- License
- W325026
- Practice address
- 132 Lucerne Dr
Debary, FL 32713-2914 - Phone
- (321) 363-6592
- NPI assigned
- May 26, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exclusive Provider Organization | 302F00000X | W325026 | FL | Primary |
Addresses
Primary practice location
132 Lucerne Dr
Debary, FL 32713-2914
Mailing address
132 Lucerne Dr
Debary, FL 32713-2914
Phone (321) 363-6592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| W325026 | FL | MD | Exclusive Provider Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464220800000",
"number": "1992153209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "132 LUCERNE DR",
"city": "DEBARY",
"state": "FL",
"postal_code": "327132914",
"telephone_number": "321-363-6592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "132 LUCERNE DR",
"city": "DEBARY",
"state": "FL",
"postal_code": "327132914",
"telephone_number": "321-363-6592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENNINGSEN",
"first_name": "DEREK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-26",
"last_updated": "2016-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "302F00000X",
"taxonomy_group": "",
"desc": "Exclusive Provider Organization",
"state": "FL",
"license": "W325026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Debary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.