Gardner Family Health Network Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GARDNER FAMILY HEALTH NETWORK INC

Practice address

3351 El Camino Real
Suite 100
Atherton, CA 94027-3811

Phone

(408) 200-2291

Fax

(408) 278-7799

NPI assigned

Apr 25, 2012

Organization subpart

Yes

Parent organization

GARDNER FAMILY HEALTH NETWORK, INC.As reported in NPPES

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

Authorized official

Name

Ofelia Ruiz

Title

Director

Phone

(408) 935-3971

Specialties & licenses 1

Addresses

Other names 1

• Gardner Packard Children's Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 751983

Legal name

GARDNER PACKARD CHILDREN'S HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 21, 2017

Last certification

Aug 21, 2017

Ownership / control type

Non-profit – church related

Facility address

3351 El Camino Real, Suite 100
Atherton, CA 94027

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

St James Health Center

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503360000000",
    "number": "1922366186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 GOLD STREET",
            "city": "ALVISO",
            "state": "CA",
            "postal_code": "950021240",
            "telephone_number": "408-200-2291",
            "fax_number": "408-935-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 EL CAMINO REAL",
            "address_2": "SUITE 100",
            "city": "ATHERTON",
            "state": "CA",
            "postal_code": "940273811",
            "telephone_number": "408-200-2291",
            "fax_number": "408-278-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GARDNER FAMILY HEALTH NETWORK, INC.",
        "enumeration_date": "2012-04-25",
        "last_updated": "2017-08-22",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "OFELIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "408-935-3971"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gardner Packard Children's Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ian Eisenberger
• Ellevatemd
• Ayshalynn Epperson, PA-C
• Robert Fennell, ATC, M.S.
• Mark Thomas Fowler, ATC
• Amir Reza Ghorbani, D.D.S
• Casey Marie Herrera, D.D.S.
• Kristen Michelle Ho, ATC
• Justin Honda
• Lawrence C. Horowitz, M.D.

• Clinic/Center in Atherton, CA
• Providers in Atherton, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.