Individual provider Active NPI

Katherine Elizabeth Gardner, N.P.

  • Family Nurse Practitioner
  • Saint Augustine, FL
National Provider Identifier
1366883209
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9404766 Issued in FL
Practice address
240 Southpark Cir E
Saint Augustine, FL 32086-5137
Phone
(904) 824-1450
NPI assigned
Jul 8, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN185338 GA
Family Nurse Practitioner 363LF0000X ARNP9404766 FL Primary

Addresses

Primary practice location

240 Southpark Cir E
Saint Augustine, FL 32086-5137

Mailing address

12109 County Road 103
Oxford, FL 34484-2951
Phone (352) 205-8981

Other identifiers 1

IdentifierTypeStateIssuer
003139757AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160519000310 FL Practitioner - Nurse Practitioner 4486884822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Urology Institute LLCGroup PAC ID 2163653585, 152 clinicians

Practice addresses (Care Compare)

545 Health Blvd
Daytona Beach, FL 32114-1493
Phone (386) 239-8500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.09 of 100Reported as group
Promoting interoperability
100
Improvement activities
40
Cost
80.3

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Urology Institute, LLC CurrentSince Apr 4, 2016 Accepting new patients
Advanced Urology Institute, LLC CurrentSince Apr 4, 2016 Accepting new patients
Advanced Urology Institute LLC Past Accepting new patients

Locations

545 Health Blvd
Daytona Beach, FL 32114
Phone (386) 239-8500

609 W Highland Blvd
Inverness, FL 34452
Phone (352) 726-9707

506 Palmetto St
New Smyrna Beach, FL 32168
Phone (386) 427-9554

12109 County Road 103
Oxford, FL 34484
Phone (352) 205-8981

240 Southpark Cir E
St Augustine, FL 32086
Phone (904) 824-1450

113 Whitehall Dr
St Augustine, FL 32086
Phone (904) 824-1450

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/uc41222_advuroswflorida
  • Direct secure messaging: kgardner744196@direct.shands.ufl.edu

Organizations & group practices 3

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 2

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": "1373241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1366883209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12109 COUNTY ROAD 103",
            "city": "OXFORD",
            "state": "FL",
            "postal_code": "344842951",
            "telephone_number": "352-205-8981",
            "fax_number": "352-391-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 SOUTHPARK CIR E",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865137",
            "telephone_number": "904-824-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KATHERINE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-08",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN185338",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9404766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003139757A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Augustine, FL

Sources for this page

Verify at the official NPI Registry.