Individual provider Active NPI

Sara Kathryn Gardiner, MD

  • Psychiatry Physician
  • Portland, OR
National Provider Identifier
1104972926
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD25527 Issued in OR
Practice address
1318 NW 20TH Ave
Suite a
Portland, OR 97209-1671
Phone
(503) 869-0428
Fax
(503) 227-8058
NPI assigned
Jan 26, 2007
Sex
Female
Sole proprietor
Yes

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD25527 OR Primary
Psychiatry Physician 2084P0800X A66614 CA

Addresses

Primary practice location

1318 NW 20TH Ave
Suite a
Portland, OR 97209-1671

Mailing address

1318 NW 20TH Ave
Suite a
Portland, OR 97209-1671
Phone (503) 869-0428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Previously, effective Aug 26, 2016 through Aug 26, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A66614CAMDPsychiatry Physician
MD25527ORMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104972926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 NW 20TH AVE",
            "address_2": "SUITE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091671",
            "telephone_number": "503-869-0428",
            "fax_number": "503-227-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 NW 20TH AVE",
            "address_2": "SUITE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091671",
            "telephone_number": "503-869-0428",
            "fax_number": "503-227-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDINER",
        "first_name": "SARA",
        "middle_name": "KATHRYN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD25527",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A66614",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.