MICHAEL G HENDERSON (PA-C) – Physician Assistant, NPI 1265423594
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MICHAEL G HENDERSON (PA-C)
165, West Commerce Drive, Belle Plaine, Scott County, Minnesota, 56011, United States
BELLE PLAINE, MN 560112911
Phone: (952) 777-5661
Type: Location
Ridgeview Medical Center, 500, South Maple Street, Waconia, Carver County, Minnesota, 55387, United States
WACONIA, MN 553871791
Phone: (952) 442-2191
Fax: (952) 442-8055
Type: Mailing
450 WILLIAMS WAY
MOAB, UT 845322185
Phone: (435) 719-3500
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $30.
Total Amount is formed as General ($30) + Research ($0) + Ownership ($0) = $30.
Last reported payment date: 2023-09-28 • Largest payer in this snapshot: Cranial Technologies, Inc ($16).
Total Amount
$30
General + Research + Ownership
Payments
2
Total payment records
General Amount
$30
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-09-28
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Cranial Technologies, Inc | $16 |
| Lilly USA, LLC | $14 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-01-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040112000302 | I | Physician Assistant | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 81002 | Urinalysis, manual test | 14 | 13 | $0 |
Insurance plans in this area (ZIP 56011)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MN | |
| Internal Medicine | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| Physician Assistant | MN | |
| Diagnostic Radiology | MN | |
| Marriage And Family Therapist | MN | |
| Physician Assistant | MN | |
| Nurse Practitioner | MN |
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