Individual provider Active NPI

Cheryl M Gardner, ARNP

  • Nurse Practitioner
  • Titusville, FL
National Provider Identifier
1467586388
Registry record updated Jun 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP3409302 Issued in FL
Practice address
3300 Dairy Rd
Titusville, FL 32796-1512
Phone
(321) 267-6687
Fax
(321) 747-0407
NPI assigned
Mar 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X ARNP3409302 FL
Nurse Practitioner 363L00000X ARNP3409302 FL Primary

Addresses

Primary practice location

3300 Dairy Rd
Titusville, FL 32796-1512

Mailing address

3300 Dairy Rd
Titusville, FL 32796-1512
Phone (321) 267-6687

Other identifiers 1

IdentifierTypeStateIssuer
004473700MedicaidFL

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
I20051212000521 FL Practitioner - Nurse Practitioner 3375564925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indian River Medical Office PAGroup PAC ID 2668527201, 3 clinicians

Practice addresses (Care Compare)

3300 Dairy Rd
Titusville, FL 32796-1512
Phone (321) 269-6530

Hospital & facility affiliations

  • Parrish Home Health Home health agency, Titusville, FL, CCN 107488
  • Centerwell Home Health Home health agency, Melbourne, FL, CCN 107112
  • Nayar Health Care Melbourne LLC Home health agency, Titusville, FL, CCN 687309
  • Parrish Medical Center Hospital, Titusville, FL, CCN 100028

Merit-based Incentive Payment System (MIPS)

Final score
94.55 of 100Reported as group
Quality
100
Improvement activities
40
Cost
75.99

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP3409302FLMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Indian River Medical Office PA CurrentSince Mar 17, 2010 Accepting new patients

Locations

3300 Dairy Rd
Titusville, FL 32796
Phone (321) 267-6687

951 N Washington Ave
Titusville, FL 32796
Phone (302) 325-5511

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BFFICA

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 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": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433808000000",
    "number": "1467586388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 DAIRY RD",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327961512",
            "telephone_number": "321-267-6687",
            "fax_number": "321-747-0407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 DAIRY RD",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327961512",
            "telephone_number": "321-267-6687",
            "fax_number": "321-747-0407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "CHERYL",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2015-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "ARNP3409302",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP3409302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004473700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

Verify at the official NPI Registry.