SHALESSE GARDNER PMHNP-BC
NPI 1750045712
Nurse Practitioner - Psychiatric/Mental Health in El Segundo, CA
About Shalesse Gardner Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHALESSE GARDNER PMHNP-BC (NPI 1750045712) is an individual psychiatric/mental health provider in El Segundo, California, licensed in California (95015664) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Beverly Hills.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shalesse Gardner Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Shalesse Gardner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
West Hollywood, CA 90046
- Reassigned Medicare billing, California enrollment
- 204 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90245 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
EL SEGUNDO, CA 90245
EL SEGUNDO, CA 90245
EL SEGUNDO, CA 90245
EL SEGUNDO, CA 90245
EL SEGUNDO, CA 90245
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Shalesse Gardner's NPI number?
The NPI number for Shalesse Gardner is 1750045712. It was assigned to this individual provider in the NPPES registry on October 26, 2021.
Where is Shalesse Gardner located?
Shalesse Gardner practices at 390 N Pacific Coast Hwy Ste 2060, El Segundo, CA 90245. The listed phone number is (855) 501-1004.
What is Shalesse Gardner's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Shalesse Gardner enrolled in Medicare?
Yes. Shalesse Gardner is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Shalesse Gardner's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shalesse Gardner reassigns Medicare benefits to Mellow Medical Inc A Professional Corporation (West Hollywood, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shalesse Gardner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Shalesse Gardner was last updated on October 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 37 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Shalesse Gardner, PMHNP-BC · NPI 1750045712
Psychiatric/Mental Health physician in El Segundo, California. Individual provider, active in the CMS NPPES registry since October 26, 2021.
## Identity
- **NPI:** 1750045712 (Entity type: Individual)
- **Enumerated:** October 26, 2021
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95015664 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 390 N PACIFIC COAST HWY STE 2060, El Segundo, CA 90245-4401
- **Phone:** (855) 501-1004
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Mellow Medical Inc A Professional Corporation (NPI 1407275886, West Hollywood, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 2, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1750045712) · Data from the CMS NPPES public registry.