Victorio M Gardner, PSYD in Detroit, MI - Medicare Psychologist Provider

Victorio M Gardner, PSYD is a medicare enrolled "Psychologist - Clinical Child & Adolescent" provider in Detroit, Michigan. His current practice location is 2799 W Grand Blvd, Detroit, Michigan. You can reach out to his office (for appointments etc.) via phone at (313) 916-2600.

Victorio M Gardner is licensed to practice in Michigan (license number 6301009431) 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 1376691964.

Contact Information

	Victorio M Gardner, PSYD
	2799 W Grand Blvd, Detroit, MI 48202-2608
	(313) 916-2600
	(313) 874-4677

Map and Direction

Healthcare Provider's Profile

Full Name	Victorio M Gardner
Gender	Male
Speciality	Psychologist - Clinical Child & Adolescent
Location	2799 W Grand Blvd, Detroit, Michigan
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1376691964
Provider Enumeration Date: 01/08/2007
Last Update Date: 09/19/2023

Medicare PECOS Information:

PECOS PAC ID: 4082947312
Enrollment ID: I20190531000747

Medical Identifiers

Medical identifiers for Victorio M Gardner such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1376691964	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	6301009431 (Michigan)	Secondary
103TC0700X	Psychologist - Clinical	6301009431 (Michigan)	Secondary
103TC2200X	Psychologist - Clinical Child & Adolescent	6301009431 (Michigan)	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. Victorio M Gardner allows following entities to bill medicare on his behalf.

Entity Name	Henry Ford Health System
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1114001468 PECOS PAC ID: 0547178311 Enrollment ID: O20031111000517

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. Victorio M 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
Victorio M Gardner, PSYD 2799 W Grand Blvd, Detroit, MI 48202-2608 Ph: (313) 916-2600	Victorio M Gardner, PSYD 2799 W Grand Blvd, Detroit, MI 48202-2608 Ph: (313) 916-2600

Reviews and Comments

Psychologist in Detroit, MI

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Victorio M Gardner, PSYD - Medicare Psychologist in Detroit, MI