NPIMap

Individual provider Active NPI

Shannon L Gardiner, PA

  • Surgical Physician Assistant
  • Meridian, ID
National Provider Identifier
1689701260
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-403 Issued in ID
Practice address
875 S Vanguard Way Ste 200
Meridian, ID 83642-8542
Phone
(208) 809-2895
Fax
(208) 809-2896
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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 PA403 ID
Surgical Physician Assistant 363AS0400X PA-403 ID Primary

Addresses

Primary practice location

875 S Vanguard Way Ste 200
Meridian, ID 83642-8542

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 985-1423

Other practice location 1

360 E Montvue Dr
Suite 100
Meridian, ID 83642-6318
Phone (208) 855-2900

Other identifiers 1

IdentifierTypeStateIssuer
806483300MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20050113000517 ID Practitioner - Physician Assistant 2264481571 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians
Chatterton Speech Therapy LLCGroup PAC ID 9234350182, 8 clinicians

Practice addresses (Care Compare)

10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500

1474 N Meridian Rd
Kuna, ID 83634-2041
Phone (208) 809-2885

1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860

260 S Ten Mile Rd
Meridian, ID 83642-6100
Phone (208) 809-2872

8601 W Emerald St
Suite 150
Boise, ID 83704-4841
Phone (208) 793-7006

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013

Merit-based Incentive Payment System (MIPS)

Final score
84.87 of 100Reported as group
Quality
77.29
Promoting interoperability
97
Improvement activities
40
Cost
74.78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA403IDMDPhysician Assistant
PA-403IDMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC CurrentSince Apr 29, 2024 Accepting new patients
Alliance Medical Group, LLC Current Accepting new patients

Locations

8601 W Emerald St
Ste 150
Boise, ID 83704
Phone (208) 321-0634

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

875 S Vanguard Way
Ste 200A
Meridian, ID 83642
Phone (208) 809-2895

875 S Vanguard Way
Ste 200
Meridian, ID 83642
Phone (208) 298-9949

Interoperability endpoints

  • Direct secure messaging: shannon.gardiner@phmg.eclinicaldirectplus.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1689701260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-985-1423",
            "fax_number": "208-955-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S VANGUARD WAY STE 200",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428542",
            "telephone_number": "208-809-2895",
            "fax_number": "208-809-2896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 E Montvue Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836426318",
            "country_code": "US",
            "telephone_number": "208-855-2900",
            "fax_number": "208-898-9877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDINER",
        "first_name": "SHANNON",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA403",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806483300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.