NPIMap

Individual provider Active NPI

Carlo Gardner

  • Physician Assistant
  • Williamsport, PA
National Provider Identifier
1366908329
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA062850 Issued in PA
Practice address
740 High St Ste 2001
Suite 2001
Williamsport, PA 17701-3102
Phone
(570) 321-2800
NPI assigned
Feb 14, 2019
Last updated
Sep 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X OA004760 PA
Physician Assistant 363A00000X MA062850 PA Primary

Addresses

Primary practice location

740 High St Ste 2001
Suite 2001
Williamsport, PA 17701-3102

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cgardner424810@upmc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20190422002472 PA Practitioner - Physician Assistant 3375885452 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, shared by 32 NPIs, 611 clinicians

Practice addresses (Care Compare)

1705 Warren Ave
Williamsport, PA 17701-2647
Phone (570) 321-2020

1705 Warren Ave
206 Susquehanna Health Urology
Williamsport, PA 17701-2664
Phone (570) 326-8090

700 High St
Williamsport, PA 17701-3100

700 High St
Williamsport, PA 17701-3198

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA062850PAMDPhysician Assistant
OA004760PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services Physician Assistant CurrentSince Oct 8, 2023 Accepting new patients
Susquehanna Physician Services Physician Assistant CurrentSince Mar 28, 2019 Accepting new patients
Susquehanna Physician Services Physician Assistant CurrentSince Sep 12, 2021 Accepting new patients
Susquehanna Physician Services CurrentSince Mar 28, 2019 Accepting new patients

Locations

1705 Warren Ave
#101103
Williamsport, PA 17701

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

700 High St
Williamsport, PA 17701
Phone (570) 321-2000

1201 Grampian Blvd
Ste 2001
Williamsport, PA 17701

740 High St
Ste 2001
Williamsport, PA 17701
Phone (570) 321-2805

Interoperability endpoints

  • Direct secure messaging: cgardner424810@upmc.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1366908329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 HIGH ST STE 2001",
            "address_2": "SUITE 2001",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013102",
            "telephone_number": "570-321-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "CARLO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-14",
        "last_updated": "2026-09-03",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA004760",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgardner424810@upmc.direct-ci.com",
            "affiliation": "N",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.