TRACY HAMBLIN HENDERSON (MD) – Sports Medicine (Family Medicine) Physician, NPI 1073839817
Sports Medicine (Family Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
188 SPORTS MEDICINE in WA
Provider Addresses for TRACY HAMBLIN HENDERSON (MD)
110 MARY LOU DR STE 100
WILLOW PARK, TX 760878767
Phone: (817) 930-2030
Fax: (817) 757-7333
Type: Mailing
PO BOX 368
OLYMPIA, WA 985070368
Phone: (315) 491-7790
Type: Mailing
3901 CAPITAL MALL DR SW
OLYMPIA, WA 985028654
Phone: (800) 936-3386
Fax: (360) 786-9010
Type: Location
110 MARY LOU DRIVE
SUITE 100
WILLOW PARK, TX 76087
Phone: (817) 930-2030
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $24.
Total Amount is formed as General ($24) + Research ($0) + Ownership ($0) = $24.
Last reported payment date: 2024-05-06 • Largest payer in this snapshot: Bioventus LLC ($24).
Total Amount
$24
General + Research + Ownership
Payments
1
Total payment records
General Amount
$24
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Bioventus LLC | $24 |
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: 2023-07-06
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 |
|---|---|---|---|---|
| I20230706000199 | I | Sports Medicine | TX | 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 |
|---|---|---|---|---|
| J1040 | Injection, methylprednisolone acetate, 80 mg | 255 | 205 | $0 |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 248 | 222 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 130 | 14 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 70 | 56 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 58 | 51 | $0 |
Insurance plans in this area (ZIP 76087)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | TX | |
| Internal Medicine | TX | |
| - | TX | |
| Nurse Practitioner | TX | |
| General Surgery, Colorectal Surgery (Proctology) | TX | |
| O P H T H A L M O L O G Y | TX | |
| Nurse Practitioner | TX | |
| - | TX | |
| - | TX | |
| Orthopedic Surgery | TX |
Reviews
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