NPIMap

Individual provider Active NPI

Kirsten Gardner, DO

  • Adult Medicine Physician
  • Roanoke, VA
National Provider Identifier
1467980177
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
0116033802 Issued in VA
Practice address
1 Riverside Cir Ste 300
Roanoke, VA 24016-4962
Phone
(540) 581-0238
NPI assigned
May 24, 2017
Last updated
Nov 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MI
Student in an Organized Health Care Education/Training Program 390200000X 0116033802 VA
Adult Medicine Physician 207QA0505X 0116033802 VA Primary

Addresses

Primary practice location

1 Riverside Cir Ste 300
Roanoke, VA 24016-4962

Mailing address

7847 Forest Edge Dr
Roanoke, VA 24018-5844

Other practice location 1

1935 W Main St
Salem, VA 24153-3109
Phone (540) 387-0441

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20211029000254 VA Practitioner - Family Practice 9436428562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Practice addresses (Care Compare)

1935 W Main St
Salem, VA 24153-3109
Phone (540) 387-0441

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0116033802VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Healthcare Corporation CurrentSince Aug 2, 2021 Accepting new patients
Carilion Healthcare Corporation CurrentSince Aug 2, 2021 Accepting new patients

Locations

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

1935 W Main St
Salem, VA 24153
Phone (540) 302-0190

Interoperability endpoints

  • Direct secure messaging: kluethy126021@direct.carilionclinic.org

Organizations & group practices 2

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 6

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": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1467980177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7847 FOREST EDGE DR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240185844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RIVERSIDE CIR STE 300",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164962",
            "telephone_number": "540-581-0238"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1935 W Main St",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "VA",
            "postal_code": "241533109",
            "country_code": "US",
            "telephone_number": "540-387-0441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KIRSTEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116033802",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "VA",
            "license": "0116033802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.