NPIMap

Individual provider Active NPI

Brian Gardner, M.D.

  • Vascular & Interventional Radiology Physician
  • Charlottesville, VA
National Provider Identifier
1356785455
Registry record updated Oct 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
82070 Issued in SC
Practice address
1215 Lee St
Box 800719
Charlottesville, VA 22908-0816
Phone
(434) 924-2150
Fax
(434) 982-1530
NPI assigned
Apr 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Vascular & Interventional Radiology Physician 2085R0204X 82070 SC Primary

Addresses

Primary practice location

1215 Lee St
Box 800719
Charlottesville, VA 22908-0816

Mailing address

1215 Lee St
Box 800719
Charlottesville, VA 22908-0816
Phone (434) 924-2150

Other identifiers 2

IdentifierTypeStateIssuer
820703MedicaidSC
SCF2284467OtherSCSC MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190726001734 SC Practitioner - Diagnostic Radiology 0547499337 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Georgia School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Roper Radiologists PAGroup PAC ID 6800700162, 40 clinicians

Practice addresses (Care Compare)

316 Calhoun St
Charleston, SC 29401-1113
Phone (843) 724-2161

Hospital & facility affiliations

  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
  • Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104
  • Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Roper Radiologists PA CurrentSince Aug 1, 2019 Accepting new patients

Locations

2085 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 577-6957

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

Organizations & group practices 1

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 10

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": "1366329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1356785455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 LEE ST",
            "address_2": "BOX 800719",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-2150",
            "fax_number": "434-982-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 LEE ST",
            "address_2": "BOX 800719",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-2150",
            "fax_number": "434-982-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-19",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "SC",
            "license": "82070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "820703",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC MEDICARE",
            "identifier": "SCF2284467",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.