Individual provider Active NPI

Holly A Gardner, MD

  • Emergency Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1396788709
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
01056402 Issued in IN
Practice address
1701 N Senate Blvd
ER Dept
Indianapolis, IN 46202-1239
Phone
(317) 962-8880
Fax
(317) 962-7086
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01056402 IN Primary

Addresses

Primary practice location

1701 N Senate Blvd
ER Dept
Indianapolis, IN 46202-1239

Mailing address

250 N Shadeland Ave
Ste 130 Provider Enrollment
Indianapolis, IN 46219-4959

Other practice location 1

2400 17th St
Columbus, IN 47201-5351
Phone (812) 379-4441

Other identifiers 1

IdentifierTypeStateIssuer
200474350MedicaidIN

Other names 1

  • Holly A Heinz Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hgardner8538@edirect.crh.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20040810000848 IN Practitioner - Emergency Medicine 4688646649 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01056402INMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Inc of Columbus Emergency Medicine CurrentSince Sep 1, 2011 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Emergency Medical Group, Inc. Emergency Medicine Past Accepting new patients

Locations

2400 17th St
Columbus, IN 47201
Phone (812) 373-3025

Interoperability endpoints

  • Direct secure messaging: hgardner8538@edirect.crh.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1396788709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "STE 130 PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N SENATE BLVD",
            "address_2": "ER DEPT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239",
            "telephone_number": "317-962-8880",
            "fax_number": "317-962-7086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 17th St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "IN",
            "postal_code": "472015351",
            "country_code": "US",
            "telephone_number": "812-379-4441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "HOLLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01056402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200474350",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hgardner8538@edirect.crh.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2400 17th St",
            "city": "Columbus",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472015351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "HEINZ",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.