NPIMap

Individual provider Active NPI

Samuel D Gardner, DO

  • Family Medicine Physician
  • Salmon, ID
National Provider Identifier
1962588111
Registry record updated Sep 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-174 Issued in ID
Practice address
805 Main St
Salmon, ID 83467-0000
Phone
(208) 756-6212
Fax
(208) 756-6336
NPI assigned
Oct 31, 2006
Last updated
Sep 26, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-174 ID Primary

Addresses

Primary practice location

805 Main St
Salmon, ID 83467-0000

Mailing address

203 S Daisy St
Salmon, ID 83467-0000
Phone (208) 756-5600

Other identifiers 1

IdentifierTypeStateIssuer
804213400MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100724000153 ID Practitioner - Family Practice 4385776418 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steele Memorial Medical CenterGroup PAC ID 9436131265, 25 clinicians

Practice addresses (Care Compare)

PO Box
Suite 700
Salmon, ID 83467

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-174IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Steele Memorial Medical Center CurrentSince Jul 1, 1998 Accepting new patients
Steele Memorial Medical Center CurrentSince Jul 1, 1998 Accepting new patients
Steele Memorial Medical Center Past Accepting new patients

Locations

203 S Daisy St
Salmon, ID 83467
Phone (208) 756-4291

805 Main St
Salmon, ID 83467
Phone (208) 282-3495

Interoperability endpoints

  • Direct secure messaging: sgardner236671@wm.providencedirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316995200000",
    "number": "1962588111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 S DAISY ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834670000",
            "telephone_number": "208-756-5600",
            "fax_number": "208-756-4169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 MAIN ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834670000",
            "telephone_number": "208-756-6212",
            "fax_number": "208-756-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "SAMUEL",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2011-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804213400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salmon, ID

Sources for this page

Verify at the official NPI Registry.