Individual provider Active NPI

Stephanie C Gardner, MD

  • Emergency Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1063447274
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD2006-0109 Issued in NM
Practice address
1100 Central Ave SE
Albuquerque, NM 87106-4930
Phone
(505) 841-1125
Fax
(505) 841-1737
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD2006-0109 NM Primary

Addresses

Primary practice location

1100 Central Ave SE
Albuquerque, NM 87106-4930

Mailing address

5901 Harper Dr NE
Provider Enrollment
Albuquerque, NM 87109-3587
Phone (505) 823-8528

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNM

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071109000239 CA Practitioner - Emergency Medicine 4789687468 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Virginia School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monterey Bay Observation MedicineGroup PAC ID 1052630514, 32 clinicians

Practice addresses (Care Compare)

23625 Holman Hwy
Monterey, CA 93940-5902
Phone (831) 625-4900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2006-0109NMMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospital of the Monterey Peninsula CurrentSince Jan 1, 2012 Accepting new patients
Monterey Bay Observation Medicine Emergency Medicine CurrentSince Feb 17, 2015 Accepting new patients
Community Hospital of the Monterey Peninsula CurrentSince Jan 1, 2012 Accepting new patients

Locations

23625 Wr Holman Hwy
Monterey, CA 93940
Phone (831) 622-2708

Organizations & group practices 3

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063447274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 HARPER DR NE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093587",
            "telephone_number": "505-823-8528",
            "fax_number": "505-823-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CENTRAL AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064930",
            "telephone_number": "505-841-1125",
            "fax_number": "505-841-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "STEPHANIE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "MD2006-0109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.