Jacob Ryan Gardner, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9118395 Issued in FL

Practice address

18167 US Highway 19 N Ste 150
Clearwater, FL 33764-6566

Phone

(727) 321-3854

NPI assigned

Feb 1, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Metropolitan Charities IncGroup PAC ID 2163668286, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Metropolitan Charities Inc

  dba Metro Healthy Communities

  • Federally Qualified Health Center (FQHC)
  • St Petersburg, FL
  • NPI 1013277060
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1528821642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 94TH AVE N STE 250",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337022448",
            "telephone_number": "727-321-3854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18167 US HIGHWAY 19 N STE 150",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337646566",
            "telephone_number": "727-321-3854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4747 US Highway 19",
            "address_purpose": "LOCATION",
            "city": "New Port Richey",
            "state": "FL",
            "postal_code": "346524945",
            "country_code": "US",
            "telephone_number": "727-321-3854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JACOB",
        "middle_name": "RYAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9118395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Mahalares Garcia, SLP
• Rosemary Lucero Garcia
• Suzanne Gonzalez Garcia, M.S., CCC-SLP
• Yanet M Garcia, COTA
• Yomira Garcia
• Katherine J.M. Gardner, L.M.H.C.
• Nicole Garland, ARNP
• Jennifer Marie Garner Jr., CST/CSFA
• Vicki Misner Garner, LMHC
• Erin E Garnett, PTA

• Medical Physician Assistant in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.