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RAVEN HENDERSON M.D.
NPI 1437415726
Plastic Surgery in Tyler, TX

Active since April 11, 2012Opted out of Medicare · through Jan 23, 2027
2140 W GRANDE BLVD STE A, TYLER, TX 75703(903) 251-2765(270) 216-6827 Get Directions Write a Review

NPPES record last updated: July 5, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 5, 2024, Jul 28, 2021, Dec 10, 2020 and 3 more (6 updates tracked since 2017).

About Raven Henderson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RAVEN HENDERSON M.D. (NPI 1437415726) is an individual plastic surgery provider in Tyler, Texas, licensed in Kansas (04-40363) and active in the NPI registry since April 2012. She has opted out of Medicare through January 23, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1437415726
Entity TypeIndividualFemale
Primary Taxonomy208200000X
Provider Legal NameRAVEN HENDERSONCredential: M.D.
Location Address2140 W GRANDE BLVD STE ATyler, TX 75703-0563
Mailing Address2140 W Grande Blvd Ste ATyler, TX 75703-0563 · (903) 251-2765 · Fax (270) 216-6827
Phone(903) 251-2765
Fax(270) 216-6827
Sole ProprietorNo
Enumeration DateApril 11, 2012
Last NPPES UpdateJuly 5, 20246 updates tracked since enumeration
NPPES CertifiedJuly 5, 2024
✔ NPI 1437415726 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208200000X
License✔ Licensed in KS · 04-40363
Definition
A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
2140 W GRANDE BLVD STE A, Tyler, TX 75703
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Raven Henderson M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 23, 2025 through January 23, 2027.

Opt-Out Effective DateJanuary 23, 2025
Opt-Out In Effect ThroughJanuary 23, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75703 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Raven Henderson's NPI number?

The NPI number for Raven Henderson is 1437415726. It was assigned to this individual provider in the NPPES registry on April 11, 2012.

Where is Raven Henderson located?

Raven Henderson practices at 2140 W Grande Blvd Ste A, Tyler, TX 75703. The listed phone number is (903) 251-2765.

What is Raven Henderson's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Is Raven Henderson enrolled in Medicare?

No. Raven Henderson has opted out of Medicare through January 23, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Raven Henderson was last updated on July 5, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.