Organization Active NPI

Gardner Family Medicine, Inc.

  • Physician Assistant
  • Gardner, MA
National Provider Identifier
1003011594
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
214124 Issued in MA
Legal business name
GARDNER FAMILY MEDICINE, INC.
Practice address
57 City Hall Ave
Gardner, MA 01440-2614
Phone
(978) 630-3862
Fax
(978) 630-4176
NPI assigned
Jun 15, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Ryan, DONPI 1467427708
Title
President
Phone
(978) 630-3862

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 214124 MA Primary
Family Medicine Physician 207Q00000X 2141244 MA

Addresses

Primary practice location

57 City Hall Ave
Gardner, MA 01440-2614

Mailing address

57 City Hall Ave
Gardner, MA 01440-2614
Phone (978) 630-3862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071022000189 MA Part B Supplier - Clinic/Group Practice 9234225343 Receives reassigned benefits from 5 practitioners
Practice locations: Gardner, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0978797Gardner Family Medicine57 City Hall Avenue, Gardner, MA 01440Provider-performed microscopyOct 2, 2026

National Provider Directory

National Provider Directory

Locations

57 City Hall Ave
Gardner, MA 01440
Phone (978) 630-3862

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1039/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1003011594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 CITY HALL AVE",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014402614",
            "telephone_number": "978-630-3862",
            "fax_number": "978-630-4176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 CITY HALL AVE",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014402614",
            "telephone_number": "978-630-3862",
            "fax_number": "978-630-4176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER FAMILY MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-630-3862",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "214124",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "2141244",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardner, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.