Dr Governor Henry Henderson Iii, DNP is a medicare enrolled "Nurse Practitioner - Family" physician in Sierra Vista, Arizona. His current practice location is
75 Colonia De Salud # 200, Sierra Vista, Arizona. You can reach out to his office (for appointments etc.) via phone at
(520) 263-2690.
Dr Governor Henry Henderson Iii is licensed to practice in Georgia (license number RN252065) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1538639497.
Physician's Profile
| Full Name | Dr Governor Henry Henderson Iii |
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| Gender | Male |
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| Speciality | Nurse Practitioner - Family |
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| Location | 75 Colonia De Salud # 200, Sierra Vista, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1538639497
- Provider Enumeration Date: 12/04/2018
- Last Update Date: 04/01/2023
Medicare PECOS Information:
- PECOS PAC ID: 4981947546
- Enrollment ID: I20190522001561
Medical Identifiers
Medical identifiers for Dr Governor Henry Henderson Iii such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1538639497 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208800000X | Urology | RN252065 (Georgia) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 288860 (Arizona) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | RN252065 (Georgia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Governor Henry Henderson Iii allows following entities to bill medicare on his behalf.
| Entity Name | Phoebe Physician Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1487899464
PECOS PAC ID: 8426112350
Enrollment ID: O20090121000583 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Governor Henry Henderson Iii is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Governor Henry Henderson Iii, DNP
75 Colonia De Salud # 200,
Sierra Vista, AZ 85635-2487
Ph: (520) 263-2690 | Dr Governor Henry Henderson Iii, DNP
75 Colonia De Salud # 200,
Sierra Vista, AZ 85635-2487
Ph: (520) 263-2690 |
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