NPIMap

Individual provider Active NPI

Patricia Gardner, MD

  • Psychiatry Physician
  • Portland, OR
National Provider Identifier
1326114760
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD17033 Issued in OR
Practice address
3034 NE MLK Jr Blvd
Portland, OR 97212-3053
Phone
(503) 936-5542
Fax
(503) 735-0912
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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 MD00040428 WA
Psychiatry Physician 2084P0800X MD17033 OR Primary

Addresses

Primary practice location

3034 NE MLK Jr Blvd
Portland, OR 97212-3053

Mailing address

3034 NE MLK Jr Blvd
Portland, OR 97212-3053
Phone (503) 936-5542

Other practice location 1

825 NW Highway 101 Ste A
Lincoln City, OR 97367-3241
Phone (541) 996-7480

Other identifiers 1

IdentifierTypeStateIssuer
8189995MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pgardner156471@samhealth.direct-ci.com

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan North Lincoln HospitalGroup PAC ID 7911816301, shared by 5 NPIs, 42 clinicians

Practice addresses (Care Compare)

825 NW Hwy 101
Lincoln City, OR 97367-3241
Phone (541) 996-7840

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Pacific Health Services, Inc Current Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Aug 20, 2018 Accepting new patients
Samaritan Pacific Health Services, Inc. Current Accepting new patients
Samaritan Pacific Health Services, Inc. CurrentSince May 2, 2019 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Oct 1, 2018 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Oct 1, 2018 Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince May 2, 2019 Accepting new patients
Samaritan North Lincoln Hospital CurrentSince Aug 20, 2018 Accepting new patients
Cascadia Health Past Accepting new patients
Samaritan North Lincoln Hospital Past Accepting new patients

Locations

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769

3043 NE 28th St
Lincoln City, OR 97367
Phone (541) 994-3661

825 NW Highway 101
Ste A
Lincoln City, OR 97367
Phone (541) 996-7480

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

Organizations & group practices 11

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 8

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": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1326114760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3034 NE MLK JR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123053",
            "telephone_number": "503-936-5542",
            "fax_number": "503-735-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3034 NE MLK JR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123053",
            "telephone_number": "503-936-5542",
            "fax_number": "503-735-0912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 NW Highway 101 Ste A",
            "address_purpose": "LOCATION",
            "city": "Lincoln City",
            "state": "OR",
            "postal_code": "973673241",
            "country_code": "US",
            "telephone_number": "541-996-7480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "PATRICIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00040428",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD17033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8189995",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgardner156471@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "825 NW Highway 101 Ste A",
            "city": "Lincoln City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973673241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.