Physician Compare National (NPI:1356552376)

HEALTHCARE PROVIDER: ROBERT HENDERSON DO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1356552376
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7416000856
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090731000531
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENDERSON
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1 ARH LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 800
	Group Practice or individual's line 2 address
City	LOW MOOR
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	24457
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490126
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEWISGALE HOSPITAL ALLEGHANY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	491300
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BATH COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y