Robert William Gardner

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

G30366 Issued in CA

Practice address

6300 E. Hwy 20
Lucerne, CA 95458

Phone

(707) 274-9299

Fax

(707) 274-9297

NPI assigned

Nov 21, 2006

Last updated

Nov 1, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

• Lucerne Community Clinic

  • Rural Health Clinic/Center
  • Lucerne, CA
  • NPI 1376609198
  Authorized official Same address or phone
• Robert W. Gardner PSG-Dr. Gardner Outpatient Program

  • Community/Behavioral Health Agency
  • Lucerne, CA
  • NPI 1023345857
  Authorized official Same address or phone

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1023183829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10458 CHATTEN COURT",
            "city": "CLEARLAKE OAKS",
            "state": "CA",
            "postal_code": "954237050",
            "telephone_number": "707-274-9299",
            "fax_number": "707-274-9297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 E. HWY 20",
            "city": "LUCERNE",
            "state": "CA",
            "postal_code": "95458",
            "telephone_number": "707-274-9299",
            "fax_number": "707-274-9297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G30366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G303660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Dale, RASI
• Julie Anne Dittemore
• Douglas H Reams Dental Corp
• Dr. Gardner Outpatient Program
• Pearlina Drummond
• Joseph Geare, P.A.
• Melissa May Hendrick
• Kimberly High
• Hilltop Recovery Services Iop
• Paul William Hofacker, PH.D.

• Addiction Medicine (Family Medicine) Physician in Lucerne, CA
• Providers in Lucerne, CA by specialty
• Addiction Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.