Rebecca Gardner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA056940 Issued in PA

Practice address

45 N Pine St
Port Allegany, PA 16743-1238

Phone

(814) 642-9655

NPI assigned

Jun 9, 2014

Last updated

Jan 4, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Rebecca Nick Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: rebecca.l.nick@upmcdirect.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.

• Charles Cole Memorial Hopstial

  • Obstetrics & Gynecology Physician
  • Coudersport, PA
  • NPI 1306875042
  NPD (past)

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

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1871906768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 N PINE ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431238",
            "telephone_number": "814-642-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 N PINE ST",
            "city": "PORT ALLEGANY",
            "state": "PA",
            "postal_code": "167431238",
            "telephone_number": "814-642-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "REBECCA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-09",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA056940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rebecca.l.nick@upmcdirect.com",
            "affiliation": "Y",
            "endpointDescription": "UPMC Cole",
            "affiliationName": "Charles Cole Memorial Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1001 E 2nd St",
            "city": "Coudersport",
            "state": "PA",
            "country_code": "US",
            "postal_code": "16915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "NICK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thad Nathan Diehl, D.C.
• Debra Ann Dresser, PA-C
• Edwin M Schott OD PC (Schott Associates Eye Care)
• Jane Evingham, RN
• Michael Jerome Farber, RPH
• Donald Ryan Geci, PA-C
• Viktorija Grajevskaja
• Heather Deimler Kio, CRNP
• Richard A Kunkel, DDS
• Daniel F Kysor

• Physician Assistant in Port Allegany, PA
• Providers in Port Allegany, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; 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.