Mark R Gardner, MD is a medicare enrolled "Preventive Medicine - Occupational Medicine" physician in East Chicago, Indiana. His current practice location is
4321 Fir St Ste 313, East Chicago, Indiana. You can reach out to his office (for appointments etc.) via phone at
(219) 392-7424.
Mark R Gardner is licensed to practice in Indiana (license number 01059461A) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1114055787.
Physician's Profile
| Full Name | Mark R Gardner |
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| Gender | Male |
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| Speciality | Preventive Medicine - Occupational Medicine |
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| Location | 4321 Fir St Ste 313, East Chicago, Indiana |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1114055787
- Provider Enumeration Date: 03/02/2007
- Last Update Date: 10/13/2017
Medicare PECOS Information:
- PECOS PAC ID: 8123320652
- Enrollment ID: I20151230001060
Medical Identifiers
Medical identifiers for Mark R Gardner such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1114055787 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | 036068695 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 01059461A (Indiana) | Secondary |
| 2083X0100X | Preventive Medicine - Occupational Medicine | 036068695 (Illinois) | Secondary |
| 2083X0100X | Preventive Medicine - Occupational Medicine | 01059461A (Indiana) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mark R Gardner allows following entities to bill medicare on his behalf.
| Entity Name | Community Care Network Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1457610487
PECOS PAC ID: 3678737012
Enrollment ID: O20120614000331 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mark R Gardner is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mark R Gardner, MD
4321 Fir St Ste 313, St Catherine Occ Hlth,
East Chicago, IN 46312-3049
Ph: (219) 392-7424 | Mark R Gardner, MD
4321 Fir St Ste 313,
East Chicago, IN 46312-3049
Ph: (219) 392-7424 |
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