Active NPI
Gary Lynn Kersten, M.D.
- Phlebology Physician
- Phoenix, AZ
National Provider Identifier
1861494197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebology Physician
- License
- 21176
- Practice address
- 9515 W Camelback Rd
Ste 108
Phoenix, AZ 85037-1355 - Phone
- (602) 428-0068
- Fax
- (602) 428-0069
- NPI assigned
- May 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 21176 | AZ | |
| Phlebology Physician | 202K00000X | 21176 | AZ | Primary |
Addresses
Primary practice location
9515 W Camelback Rd
Ste 108
Phoenix, AZ 85037-1355
Mailing address
9515 W Camelback Rd
Ste 108
Phoenix, AZ 85037-1355
Phone (602) 428-0068
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 173873 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21176 | AZ | MD | Phlebology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| GNR Ventures LLC | Past | Accepting new patients | |
| Gary Kersten MD PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- Phoenix, AZ
- NPI 1568535714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377907200000",
"number": "1861494197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9515 W CAMELBACK RD",
"address_2": "STE 108",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850371355",
"telephone_number": "602-428-0068",
"fax_number": "602-428-0069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9515 W CAMELBACK RD",
"address_2": "STE 108",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850371355",
"telephone_number": "602-428-0068",
"fax_number": "602-428-0069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERSTEN",
"first_name": "GARY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2013-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AZ",
"license": "21176",
"primary": false
},
{
"code": "202K00000X",
"taxonomy_group": "",
"desc": "Phlebology",
"state": "AZ",
"license": "21176",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "173873",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.