NPIMap

Individual provider Active NPI

Kelly Gardner, PA-C

  • Physician Assistant
  • Chardon, OH
National Provider Identifier
1629315239
Registry record updated Nov 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
13207 Ravenna Rd
Chardon, OH 44024-7032
Phone
(330) 656-9304
Fax
(330) 656-5901
NPI assigned
Jan 16, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X OH Primary

Addresses

Primary practice location

13207 Ravenna Rd
Chardon, OH 44024-7032

Mailing address

5700 Darrow Rd
Suite 106
Hudson, OH 44236-5026
Phone (330) 656-9304

Other names 1

  • Kelly Pintchuk Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20131212000616 OH Practitioner - Physician Assistant 2860629185 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Uh Regional Hospitals CurrentSince Feb 3, 2023 Accepting new patients
University Primary Care Practices Past Accepting new patients
University Hospitals Medical Group Inc Past Accepting new patients
University Hospitals Regional Practices LLC Past Accepting new patients

Locations

3315 N Ridge Rd E
Ste 700A
Ashtabula, OH 44004
Phone (440) 484-2130

13207 Ravenna Rd
Chardon, OH 44024
Phone (440) 285-5004

Interoperability endpoints

  • Direct secure messaging: kgardner28461@ehrdirect.uhhospitals.org

Organizations & group practices 12

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 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Primary Care Practices Inc 1,071 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

158 W Main Rd
Conneaut, OH 44030-2039

Hospital & facility affiliations

  • Capital Health Home Care Home health agency, Ashtabula, OH, CCN 367251
  • Uhhs Memorial Hospital of Geneva Hospital, Geneva, OH, CCN 361307
  • Uh Regional Hospitals Hospital, Chardon, OH, CCN 360075
  • University Hospitals Conneaut Medical Center Hospital, Conneaut, OH, CCN 361308
  • Lake Health Hospital, Concord, OH, CCN 360098
  • Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137

NPI Registry JSON

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

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447718400000",
    "number": "1629315239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 DARROW RD",
            "address_2": "SUITE 106",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442365026",
            "telephone_number": "330-656-9304",
            "fax_number": "330-656-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13207 RAVENNA RD",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440247032",
            "telephone_number": "330-656-9304",
            "fax_number": "330-656-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-16",
        "last_updated": "2015-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PINTCHUK",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chardon, OH

Sources for this page

Verify at the official NPI Registry.