Individual provider Active NPI

Jenna Gloria Gardner, CAA

  • Anesthesiologist Assistant
  • Fort Wayne, IN
National Provider Identifier
1003560277
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
75000170A Issued in IN
Practice address
10315 Dawsons Creek Blvd Ste Ab
Fort Wayne, IN 46825-1912
Phone
(260) 436-7875
NPI assigned
Feb 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X AA2000022 DC
Anesthesiologist Assistant 367H00000X 75000170A IN Primary

Addresses

Primary practice location

10315 Dawsons Creek Blvd Ste Ab
Fort Wayne, IN 46825-1912

Mailing address

PO Box 843603
Dallas, TX 75284-3603
Phone (972) 233-1999

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240220002240 IN Practitioner - Anesthesiology Assistant 1052790763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists of Fort Wayne PCGroup PAC ID 2264412444, 101 clinicians

Practice addresses (Care Compare)

4023 Reas LN
New Albany, IN 47150-2228
Phone (812) 206-7660

Hospital & facility affiliations

  • Physicians' Medical Center LLC Hospital, New Albany, IN, CCN 150172
  • Baptist Health Floyd Hospital, New Albany, IN, CCN 150044

Merit-based Incentive Payment System (MIPS)

Final score
67.76 of 100Reported as group
Quality
62.07
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
AA2000022DCMDAnesthesiologist Assistant
75000170AINMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists of Fort Wayne PC Anesthesiologist Assistant CurrentSince Feb 6, 2024 Accepting new patients
U S Anesthesia Partners of Kentucky PSC Anesthesiologist Assistant CurrentSince Feb 11, 2024 Accepting new patients

Locations

1316 E 7th St
Auburn, IN 46706
Phone (260) 925-4600

10315 Dawsons Creek Blvd
Ste Ab
Fort Wayne, IN 46825
Phone (219) 436-7875

6435 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 436-7875

4023 Reas Ln
New Albany, IN 47150
Phone (502) 690-6425

12222 Merit Dr
Ste 600
Dallas, TX 75251
Phone (972) 361-1844

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1003560277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843603",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752843603",
            "telephone_number": "972-233-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10315 DAWSONS CREEK BLVD STE AB",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251912",
            "telephone_number": "260-436-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JENNA",
        "middle_name": "GLORIA",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-07",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "DC",
            "license": "AA2000022",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000170A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; 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.