Individual provider Active NPI

Gary S Meredith, M.D.

  • Rheumatology Physician
  • Jericho, NY
National Provider Identifier
1659383503
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
56383 Issued in CT
Practice address
425 N Broadway Unit 698
Jericho, NY 11753-5034
Phone
(516) 650-4733
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 151225 NY
Rheumatology Physician 207RR0500X 1258 WI
Rheumatology Physician 207RR0500X 56383 CT Primary

Addresses

Primary practice location

425 N Broadway Unit 698
Jericho, NY 11753-5034

Mailing address

425 N Broadway Unit 698
Jericho, NY 11753-5034
Phone (516) 650-4733

Other practice location 1

1836 South Ave
LA Crosse, WI 54601-5429
Phone (608) 782-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, AZ, WI, WV, NJ5 enrollments
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 5

Enrollment IDStateProvider typePAC IDDetails
I20110119000324 NY Practitioner - RheumatologyPractitioner - Internal Medicine 2466631775 Practice locations: Rockville Centre, NY
I20160906001929 AZ Practitioner - Rheumatology 2466631775 Reassigns benefits to 1 organization
I20190411000466 WI Practitioner - Rheumatology 2466631775 Reassigns benefits to 2 organizations
I20230811002334 WV Practitioner - Rheumatology 2466631775
I20260623004712 NJ Practitioner - Internal MedicinePractitioner - Rheumatology 2466631775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Rheumatology
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kingman Healthcare IncGroup PAC ID 6901791367, 185 clinicians

Practice addresses (Care Compare)

123 Franklin Corner Rd
Suite 106
Lawrence Township, NJ 08648-2526
Phone (609) 896-2505

1739 E Beverly Ave
Suite 209
Kingman, AZ 86409-3593
Phone (928) 627-8520

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56383CTMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Medical Center, Inc CurrentSince Jul 28, 2021 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Kingman Healthcare, Inc CurrentSince Sep 1, 2016 Accepting new patients
Kingman Healthcare, Inc Family Medicine Current Accepting new patients
Kingman Healthcare, Inc CurrentSince Sep 1, 2016 Accepting new patients
Dean Health Systems, Inc. CurrentSince Apr 1, 2019 Accepting new patients
Dean Health Systems, Inc Family Medicine CurrentSince Apr 1, 2019 Accepting new patients
Gundersen Lutheran Medical Center, Inc. CurrentSince Jul 28, 2021 Accepting new patients
Kingman Healthcare, Inc Family Medicine Past Accepting new patients

Locations

3801 Santa Rosa Dr
Ste 301
Kingman, AZ 86401
Phone (928) 681-8730

1739 E Beverly Ave
Ste 209
Kingman, AZ 86409
Phone (928) 627-8520

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

Interoperability endpoints

  • Direct secure messaging: meredith.gary@st.direct.azkrmc.md

Organizations & group practices 10

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1659383503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N BROADWAY UNIT 698",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117535034",
            "telephone_number": "516-650-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N BROADWAY UNIT 698",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117535034",
            "telephone_number": "516-650-4733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEREDITH",
        "first_name": "GARY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NY",
            "license": "151225",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "WI",
            "license": "1258",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "CT",
            "license": "56383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jericho, NY

Sources for this page

Verify at the official NPI Registry.