Mario Gardner, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11006004 Issued in FL

Practice address

137 Crystal Beach Dr Ste 121
Destin, FL 32541-3573

Phone

(850) 807-4388

Fax

(850) 862-0605

NPI assigned

Nov 4, 2019

Last updated

Feb 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, AL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Group practices

Icare Mobile Medicine, LLCGroup PAC ID 5890193478, 5 clinicians

Gulf Coast Pain Consultants LLCGroup PAC ID 1658516570, 37 clinicians

Ibrahim Heart Clinic PLLCGroup PAC ID 4688958648, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Hospital Hospital, Pensacola, FL, CCN 100093
• Santa Rosa Medical Center Hospital, Milton, FL, CCN 100124

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mario.gardner.1@11679.direct.athenahealth.com
• Direct secure messaging: mgardner@cvi.curemd.direct-ci.com

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.

• Gulf Coast Pain Consultants LLC

  dba Clearway Pain Solutions Institute

  • Interventional Pain Medicine Physician
  • Pensacola, FL
  • NPI 1669712287

  AL

  Medicare reassignment Care Compare group NPD
• Ibrahim Heart Clinic PLLC

  • Clinical Cardiac Electrophysiology Physician
  • Jacksonville, FL
  • NPI 1629511035
  Medicare reassignment Care Compare group NPD
• Icare Mobile Medicine LLC

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1376215111
  Medicare reassignment Care Compare group NPD
• Healogics Specialty Physicians of Alabama, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Alexander City, AL
  • NPI 1992189443
  Medicare reassignment NPD
• Gulf Coast Pain Consultants LLC

  dba Clearway Pain Solutions Institute

  • Durable Medical Equipment & Medical Supplies
  • Fort Walton Beach, FL
  • NPI 1083455299
  NPD
• Gulf Coast Pain Consultants LLC

  dba Clearway Pain Solutions Institute

  • Pain Medicine (Anesthesiology) Physician
  • Pensacola, FL
  • NPI 1265099386
  NPD
• Gulf Coast Pain Consultants LLC

  dba Clearway Pain Solutions Institute

  • Pain Medicine (Anesthesiology) Physician
  • Atmore, AL
  • NPI 1689231722
  NPD
• Advanced Wound Systems LLC

  • Durable Medical Equipment & Medical Supplies
  • St Petersburg, FL
  • NPI 1508054271
  NPD (past)

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

• Baptist Health Care, Inc

  • General Acute Care Hospital
  • Pensacola, FL
  • NPI 1700979465
  Care Compare affiliation
• Hma Santa Rosa Medical Center LLC

  dba Santa Rosa Medical Center

  • General Acute Care Hospital
  • Milton, FL
  • NPI 1528015302
  Care Compare affiliation

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1679117451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476651",
            "telephone_number": "508-623-9798",
            "fax_number": "850-862-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 CRYSTAL BEACH DR STE 121",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325413573",
            "telephone_number": "850-807-4388",
            "fax_number": "850-862-0605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "917 Mar Walt Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325476651",
            "country_code": "US",
            "telephone_number": "850-862-3979",
            "fax_number": "850-862-0605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "MARIO",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-04",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11006004",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9265919",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "FL",
            "license": "APRN11006004",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Frierson
• Sarah Katie Fulghum, PT
• Russell Pen Gaines, LMT
• John A. Galdamez, APRN
• Kimberly Garcia, DMD
• Carol Elise Garner-Houston, OTR/L
• Stefanie Michelle Garrity, MS-CCC/SLP
• Lloyd Dale Gauvin, D.O
• Genesiscare USA of Florida LLC (Thomas J. Shaknovsky, DO)
• George Novak Plastic Surgery PA

• Nurse Practitioner in Destin, FL
• Providers in Destin, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.