Charles J Gardner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1600 S 20TH Ave
Safford, AZ 85546-4011

Phone

(928) 348-4000

NPI assigned

Oct 4, 2017

Last updated

Jul 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mt Graham Regional Medical Center Inc

  • Critical Access Hospital
  • Safford, AZ
  • NPI 1275588345
  Medicare reassignment NPD

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

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1902316946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S 20TH AVENUE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464011",
            "telephone_number": "928-348-4021",
            "fax_number": "844-271-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464011",
            "telephone_number": "928-348-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "CHARLES",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-04",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy M Fulps, RDH
• Anita Garcia, RN
• Dana M Garcia, PA
• Marvin Raul Garcia, PA-C
• Benjamin Lorenzo Gardea Jr., D.M.D.
• Robert L Garrett, O.D.
• Leslie R Garwood, RN
• Gary L. Muncy M.D., P.C.
• Daniel Leroy Gibbons, OTD, OTR/L
• Gila Valley Clinic PC (Gila Valley Clinic)

• Physician Assistant in Safford, AZ
• Providers in Safford, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.