Individual provider Active NPI

Kerry Gardner, PA-C

  • Physician Assistant
  • Madison, WI
National Provider Identifier
1750933875
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4747-23 Issued in WI
Practice address
4602 Eastpark Blvd
Madison, WI 53718-2002
Phone
(608) 263-7540
NPI assigned
Jul 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4747-23 WI Primary

Addresses

Primary practice location

4602 Eastpark Blvd
Madison, WI 53718-2002

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531
Phone (608) 829-5485

Other identifiers 1

IdentifierTypeStateIssuer
1750933875MedicaidWI

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address kgardner291164@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address kgardner936558@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20190815000616 WI Practitioner - Physician Assistant 0547597411 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 S Park St
Madison, WI 53715-1375
Phone (608) 287-2000

4602 Eastpark Blvd
Madison, WI 53718-2002
Phone (608) 440-6400

600 Highland Ave
Madison, WI 53792-0001
Phone (608) 263-6400

7974 Uw Health CT
Middleton, WI 53562-5531

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 13, 2021 Accepting new patients
Dean Health Systems, Inc. CurrentSince Aug 19, 2019 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 13, 2021 Accepting new patients
Dean Health Systems, Inc CurrentSince Aug 19, 2019 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1 S Park St
Madison, WI 53715
Phone (608) 287-2000

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

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

4602 Eastpark Blvd
Madison, WI 53718
Phone (608) 263-7540

752 N High Point Rd
Madison, WI 53717
Phone (608) 824-4000

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

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

Interoperability endpoints

  • Direct secure messaging: kgardner936558@direct.uwhealth.org
  • Direct secure messaging: kgardner634913@direct.unitypoint.org
  • Direct secure messaging: kgardner291164@direct-ehr-ssmhc.com

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 and National Provider Directory roles.

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": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1750933875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531",
            "telephone_number": "608-829-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 EASTPARK BLVD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537182002",
            "telephone_number": "608-263-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KERRY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4747-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750933875",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgardner291164@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kgardner291164@direct-ehr-ssmhc.com",
            "address_1": "752 N High Point Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537172236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "752 N High Point Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537172236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgardner936558@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "4602 Eastpark Blvd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537182002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.