Individual provider Active NPI

Bethany Marie Gardner, PA-C

  • Physician Assistant
  • McKinney, TX
National Provider Identifier
1669831657
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11052 Issued in TX
Practice address
6210 Virginia Pkwy
McKinney, TX 75071-5504
Phone
(972) 548-5377
NPI assigned
Feb 18, 2016
Last updated
Feb 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11052 TX Primary
Physician Assistant 363A00000X 1295303 ND

Addresses

Primary practice location

6210 Virginia Pkwy
McKinney, TX 75071-5504

Mailing address

6210 Virginia Pkwy
McKinney, TX 75071-5504
Phone (972) 548-5377

Other names 1

  • Bethany Marie Bloom Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170119002485 TX Practitioner - Physician Assistant 6507165057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2201 Inwood Rd
Dallas, TX 75235-7320
Phone (214) 645-2700

5939 Harry Hines Blvd
Dallas, TX 75390-0001
Phone (214) 645-0624

6202 Harry Hines Blvd
Dallas, TX 75390-0001
Phone (214) 645-4673

6202 Harry Hines Blvd
Dallas, TX 75390-9293
Phone (817) 987-3955

6303 Harry Hines
Suite 302
Dallas, TX 75390-0001
Phone (214) 645-0624

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1295303NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Nov 1, 2021 Accepting new patients
Texas Health Physicians Group CurrentSince Nov 1, 2021 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Dec 19, 2016 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Dec 19, 2016 Accepting new patients
Texas Health Physicians Group PastSince Oct 1, 2021 Accepting new patients

Locations

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

6171 Virginia Pkwy
Ste 200
McKinney, TX 75071
Phone (972) 548-5363

6210 Virginia Pkwy
McKinney, TX 75071
Phone (214) 733-8326

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 6

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 1

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": "1455753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1669831657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 VIRGINIA PKWY",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750715504",
            "telephone_number": "972-548-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 VIRGINIA PKWY",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750715504",
            "telephone_number": "972-548-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "BETHANY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-18",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11052",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "1295303",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "BLOOM",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in McKinney, TX

Sources for this page

Verify at the official NPI Registry.