Individual provider Active NPI

Andrew Ellis Gardner, MD

  • Internal Medicine Physician
  • Spokane Valley, WA
National Provider Identifier
1902268238
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
61395632 Issued in WA
Practice address
15812 E Indiana Ave
Spokane Valley, WA 99216-1875
Phone
(509) 444-8200
NPI assigned
Mar 25, 2016
Last updated
Jun 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M-14830 ID
Internal Medicine Physician 207R00000X 61395632 WA Primary

Addresses

Primary practice location

15812 E Indiana Ave
Spokane Valley, WA 99216-1875

Mailing address

15812 E Indiana Ave
Spokane Valley, WA 99216-1875
Phone (509) 444-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200513000817 ID Practitioner - Internal Medicine 7012256605 Reassigns benefits to 1 organization
I20230501002472 WA Practitioner - Internal Medicine 7012256605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Michigan Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 W 2ND Ave
Spokane, WA 99201-4503
Phone (509) 835-1206

15812 E Indiana Ave
Spokane Valley, WA 99216-1875
Phone (509) 444-8200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-14830IDMDInternal Medicine Physician
61395632WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Benewah Medical Center CurrentSince Apr 7, 2020 Accepting new patients
Community Health Association of Spokane CurrentSince Jun 1, 2023 Accepting new patients
Community Health Association of Spokane Current Accepting new patients
Community Health Association of Spokane CurrentSince Jun 1, 2023 Accepting new patients

Locations

427 12th St
Plummer, ID 83851
Phone (208) 686-5081

1720 2nd St
Cheney, WA 99004
Phone (509) 444-8202

914 W Carlisle Ave
Spokane, WA 99205
Phone (509) 325-0393

3919 N Maple St
Spokane, WA 99205
Phone (509) 326-6900

1001 W 2nd Ave
Spokane, WA 99201
Phone (509) 835-1205

611 N Iron Bridge Way
Spokane, WA 99202

5901 N Lidgerwood St
Ste 126
Spokane, WA 99208
Phone (509) 434-1990

5921 N Market St
Spokane, WA 99208
Phone (509) 487-1604

5620 S Regal St
Ste 11
Spokane, WA 99223
Phone (509) 340-1590

15812 E Indiana Ave
Spokane Valley, WA 99216

1502 N Vercler Rd
Spokane Valley, WA 99216
Phone (509) 444-8204

Interoperability endpoints

  • Direct secure messaging: andrew.gardner.1@11411.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1902268238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15812 E INDIANA AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161875",
            "telephone_number": "509-444-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15812 E INDIANA AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161875",
            "telephone_number": "509-444-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "ANDREW",
        "middle_name": "ELLIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-25",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M-14830",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "61395632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.