Dean Gardner
Individual provider Active NPI Family Nurse Practitioner · Pulaski, NY
NPI 1124415229 · NPPES record last updated Jan 20, 2022
Key facts
- NPI
- 1124415229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- F344984 (NY)
- Practice address
- 61 Delano St
Pulaski, NY 13142-1400 - Phone
- (315) 298-6564
- Fax
- (315) 298-7488
- NPI assigned
- Apr 16, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northern Oswego County Health Services, Inc.
Practice addresses (Care Compare)
61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6569
Hospital & facility affiliations
- Oswego Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191028000794 | NY | Practitioner - Nurse Practitioner | 0345560017 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F344984 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Oswego County Health Services, Inc. | Current |
Accepting new patients | |
| Camillus Physical Therapy and Sports Rehabilitation | Physical Therapist | Past |
Accepting new patients |
Locations
61 Delano St
Pulaski, NY 13142
Phone (315) 298-4274
Interoperability endpoints
- dean.gardner@nochsi.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 023498 | NY | |
| Family Nurse Practitioner | 363LF0000X | F344984 | NY | Yes |
Addresses
Primary practice location
61 Delano St
Pulaski, NY 13142-1400
Mailing address
61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6564
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Pulaski |
NPI Registry JSON
{
"created_epoch": "1429142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642636800000",
"number": "1124415229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 DELANO ST",
"city": "PULASKI",
"state": "NY",
"postal_code": "131421400",
"telephone_number": "315-298-6564",
"fax_number": "315-298-7488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 DELANO ST",
"city": "PULASKI",
"state": "NY",
"postal_code": "131421400",
"telephone_number": "315-298-6564",
"fax_number": "315-298-7488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "DEAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-16",
"last_updated": "2022-01-20",
"certification_date": "2022-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "023498",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "F344984",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Pulaski",
"affiliation": "N",
"address_1": "61 Delano St",
"city": "Pulaski",
"state": "NY",
"country_code": "US",
"postal_code": "131421400",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pulaski, NY
- William E Downey
- Sharon A Ellis
- Blaze Fahnestock
- Gary H Finnerty
- Jeffery D Ford
- Sidney Elizabeth Germinio
- Ashley Marie Gilbert
- Kathryn Quinn Giles
- Nancy Ann Glazier
- Anna Gofman
All providers in Pulaski, NY · Family Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.