Eric J. Gardner, PSY. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

24300 Issued in CA

Practice address

516 East Nizhoni Blvd.
Gallup, NM 87301-1337

Phone

(505) 722-1000

Fax

(505) 722-1396

NPI assigned

Sep 19, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ehab Yacoub MD Inc.

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  Medicare reassignment NPD
• Round Valley Indian Health Center, Inc.

  • Clinic/Center
  • Covelo, CA
  • NPI 1669532750
  Medicare reassignment

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1861688269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1337",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873051337",
            "telephone_number": "505-722-1000",
            "fax_number": "505-722-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 EAST NIZHONI BLVD.",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873011337",
            "telephone_number": "505-722-1000",
            "fax_number": "505-722-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "ERIC",
        "middle_name": "J.",
        "credential": "PSY. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-19",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY24300",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "PSB33057",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "24300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCH. ASSISTANT NUMBER",
            "identifier": "PSB33057",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicolette Garcia
• Roen Garcia, M.D.
• Sandra Marie Garcia, MD
• Susan Garcia, RN
• Victoria L Garcia
• Patricia Garrard, RN
• Luis Orlando Gasca
• Sara Gasparich, RN
• Annette R Gates
• Anita Marie Gautreaux

• Clinical Psychologist in Gallup, NM
• Providers in Gallup, NM by specialty
• Clinical Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; 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.