Kelly Robert Gardner, M.D.

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

6324 Issued in NV

Practice address

3061 S Maryland Pkwy
Suite 102
Las Vegas, NV 89109-2298

Phone

(702) 731-2888

Fax

(702) 696-9289

NPI assigned

Jan 6, 2006

Last updated

Dec 28, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Diagnostic Radiology

Education

Tulane University School of Medicine, 1985

Medicare assignment

May accept Medicare assignment

Group practices

Radiology Specialists LTD Marasso-MillerGroup PAC ID 0143110874, 136 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sunrise Hospital and Medical Center Hospital, Las Vegas, NV, CCN 290003
• Mountainview Hospital Hospital, Las Vegas, NV, CCN 290039

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Radiology Specialists LTD Marasso-Miller

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1437196979

  Vascular & Interventional Radiology

  Medicare reassignment Care Compare group NPD
• Red Rock at Maryland Parkway LLC

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1770686271
  NPD (past)

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

• Sunrise Hospital and Medical Center, LLC

  dba Sunrise Hospital and Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1861439952
  Care Compare affiliation
• Sunrise Mountainview Hospital, Inc.

  dba Mountainview Hospital

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1104870187
  Care Compare affiliation

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356652800000",
    "number": "1255319463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 202",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536",
            "telephone_number": "877-406-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3061 S MARYLAND PKWY",
            "address_2": "SUITE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092298",
            "telephone_number": "702-731-2888",
            "fax_number": "702-696-9289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KELLY",
        "middle_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2012-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NV",
            "license": "6324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200290213",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE",
            "identifier": "NV1309",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn Faye Gardner, LVN
• Faith Gardner
• Howard Gardner
• John Gardner, PHARMD
• Judie Gardner
• Kiante' Gardner, RBT
• Leah Gardner
• Mary Dean Gardner
• Melanie Gardner, SW
• Melissa Lynn Gardner

• Vascular & Interventional Radiology Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Vascular & Interventional Radiology Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.
• 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.