Active NPI
Ronald Shearer Gardner, MD
- Surgery Physician
- Polson, MT
National Provider Identifier
1881610863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 12233
- Practice address
- 6 13TH Ave E
Polson, MT 59860-5315 - Phone
- (406) 883-5680
- Fax
- (406) 883-8910
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 5117A | WY | |
| Surgery Physician | 208600000X | 12233 | MT | Primary |
Addresses
Primary practice location
6 13TH Ave E
Polson, MT 59860-5315
Mailing address
PO Box 1010
Polson, MT 59860-1010
Phone (406) 883-5680
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5117A | Other | WY | PHYSICIAN LICENSE |
| 107193900 | Medicaid | WY |
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 |
|---|---|---|---|
| 12233 | MT | MD | Surgery Physician |
| 5117A | WY | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374019200000",
"number": "1881610863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1010",
"city": "POLSON",
"state": "MT",
"postal_code": "598601010",
"telephone_number": "406-883-5680",
"fax_number": "406-883-8910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 13TH AVE E",
"city": "POLSON",
"state": "MT",
"postal_code": "598605315",
"telephone_number": "406-883-5680",
"fax_number": "406-883-8910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "RONALD",
"middle_name": "SHEARER",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2013-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WY",
"license": "5117A",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MT",
"license": "12233",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN LICENSE",
"identifier": "5117A",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "107193900",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Polson, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.