Individual provider Active NPI

Maryam Gardezi, M.D.

  • Cardiovascular Disease Physician
  • West Allis, WI
National Provider Identifier
1386817989
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
47377-020 Issued in WI
Practice address
2424 S 90TH St
West Allis, WI 53227-2455
Phone
(414) 328-8150
NPI assigned
Apr 4, 2008
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 47377-020 WI Primary

Addresses

Primary practice location

2424 S 90TH St
West Allis, WI 53227-2455

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other identifiers 1

IdentifierTypeStateIssuer
35129300MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mgardezi20648@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20080613000391 WI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6103997424 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

2424 S 90TH St
West Allis, WI 53227-2455
Phone (414) 328-8630

8901 W Lincoln Ave
West Allis, WI 53227-2409
Phone (414) 329-5930

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47377-020WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Dec 1, 2008 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Dec 1, 2008 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Dec 1, 2020 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Mar 9, 2009 Accepting new patients
West Allis Memorial Hospital, Inc. CurrentSince Sep 1, 2008 Accepting new patients
A2Cl Services, LLC Current Accepting new patients
West Allis Memorial Hospital, Inc. CurrentSince Sep 1, 2008 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Dec 1, 2020 Accepting new patients
Aurora Medical Group, Inc. PastSince Jan 1, 2024 Accepting new patients

Locations

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

12500 W Bluemound Rd
Elm Grove, WI 53122
Phone (262) 780-3434

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

2845 Greenbrier Rd
#1
Green Bay, WI 54311
Phone (920) 288-8100

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

5017 S 110th St
Milwaukee, WI 53228
Phone (414) 427-8282

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

8400 Washington Ave
Mount Pleasant, WI 53406
Phone (262) 231-3000

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

8901 W Lincoln Ave
Ste 401
West Allis, WI 53227
Phone (414) 329-5651

2424 S 90th St
Ste 300
West Allis, WI 53227
Phone (414) 328-8150

8901 W Lincoln Ave
West Allis, WI 53227
Phone (414) 328-6000

8901 W Lincoln Ave
Ste 411
West Allis, WI 53227
Phone (414) 329-5400

8905 W Lincoln Ave
Ste 401
West Allis, WI 53227
Phone (414) 328-8270

2424 S 90th St
West Allis, WI 53227
Phone (414) 321-2255

205 Valley Ave
West Bend, WI 53095
Phone (262) 338-1123

Interoperability endpoints

  • Direct secure messaging: mgardezi20648@direct.myadvocateaurora.org

Organizations & group practices 9

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 4

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": "1207267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1386817989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-328-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDEZI",
        "first_name": "MARYAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-04",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "47377-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35129300",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgardezi20648@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8901 W Lincoln Ave Ste 411",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "8901 W Lincoln Ave Ste 411",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.