Gino Jose Bardi Lola, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

65304 Issued in AZ

Practice address

815 E 15TH St
Douglas, AZ 85607-1631

Phone

(520) 364-5437

NPI assigned

Apr 21, 2016

Last updated

Feb 14, 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gino.bardilola.d1.p1@direct.cchci.nextgenshare.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.

• Chiricahua Community Health Centers, Inc

  dba Business Office

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1942241443
  Medicare reassignment NPD
• Chiricahua Community Health Centers Inc

  dba Douglas Acute Care, Laboratory, and Pharmacy

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1124803648
  NPD
• Chiricahua Community Health Centers, Inc.

  dba Willcox Clinic

  • Federally Qualified Health Center (FQHC)
  • Willcox, AZ
  • NPI 1285488866
  NPD

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1700230109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 N F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071920",
            "telephone_number": "520-459-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E 15TH ST",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071631",
            "telephone_number": "520-364-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARDI LOLA",
        "first_name": "GINO",
        "middle_name": "JOSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-21",
        "last_updated": "2024-02-14",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "65304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arizona Ambulance of Douglas, Inc.
• Arizona Caring Social Services, L.L.C.
• Arizona Em-I Medical Services
• Arizona Family Care Associates, Inc
• Nicole Marie Baldenegro, FNP
• Shirley L. Bayham-Hicks, FNP
• Karina Celeste Bechtold, FNP
• Brian Beltran
• Bisbee Hospital Association (Copper Queen Community Hospital)
• Bisbee Hospital Association (Copper Queen Medical Associates-Douglas)

• Pediatrics Physician in Douglas, AZ
• Providers in Douglas, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.