Individual provider Active NPI

Ross A Gardner, D.C.

  • Chiropractor
  • Vero Beach, FL
National Provider Identifier
1972970648
Registry record updated Jun 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11787 Issued in FL
Practice address
333 17TH St
Ste N
Vero Beach, FL 32960-5686
Phone
(772) 563-2900
Fax
(772) 563-2961
NPI assigned
Aug 28, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 012691 NY
Chiropractor 111N00000X 11787 FL Primary

Addresses

Primary practice location

333 17TH St
Ste N
Vero Beach, FL 32960-5686

Mailing address

333 17TH St
Ste N
Vero Beach, FL 32960-5686
Phone (772) 563-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160415000001 FL Practitioner - Chiropractic 9739487331 Practice locations: Vero Beach, FL

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

777 37TH St
Suite B107
Vero Beach, FL 32960-7301
Phone (772) 563-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012691NYMDMental Health Counselor
11787FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth Gilmore DC PA Chiropractor PastSince Sep 29, 2003 Accepting new patients
Beachside Detox LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1972970648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 17TH ST",
            "address_2": "STE N",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329605686",
            "telephone_number": "772-563-2900",
            "fax_number": "772-563-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 17TH ST",
            "address_2": "STE N",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329605686",
            "telephone_number": "772-563-2900",
            "fax_number": "772-563-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "ROSS",
        "middle_name": "A",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-28",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "012691",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "11787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.