Active NPI
Caleb Gardner, MD
- Psychiatry Physician
- Cambridge, MA
National Provider Identifier
1871906537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 273877
- Practice address
- 875 Mass Ave Ste 21
Cambridge, MA 02139-3070 - Phone
- (617) 665-1000
- NPI assigned
- Jun 10, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 273877 | MA | Primary |
Addresses
Primary practice location
875 Mass Ave Ste 21
Cambridge, MA 02139-3070
Mailing address
58 Highland St
Cambridge, MA 02138-3332
Phone (617) 480-6946
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 28, 2023 through Nov 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 273877 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625616000000",
"number": "1871906537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 HIGHLAND ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021383332",
"telephone_number": "617-480-6946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "875 MASS AVE STE 21",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021393070",
"telephone_number": "617-665-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "CALEB",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-10",
"last_updated": "2021-07-07",
"certification_date": "2021-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "273877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.