Individual provider Active NPI

Punita Gupta, M.D.

  • Specialist
  • Chicago, IL
National Provider Identifier
1073709457
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA09328300 Issued in NJ
Practice address
840 S Wood St
Chicago, IL 60612-4325
Phone
(312) 996-6043
NPI assigned
Sep 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125053691 IL
Specialist 174400000X 25MA09328300 NJ Primary

Addresses

Primary practice location

840 S Wood St
Chicago, IL 60612-4325

Mailing address

21 Read Ave
Tuckahoe, NY 10707-3213

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131209000676 NJ Practitioner - Pediatric Medicine 0042447583 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical Group PCGroup PAC ID 8628470325, 217 clinicians

Practice addresses (Care Compare)

703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-6331

Hospital & facility affiliations

  • St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA09328300NJMDSpecialist
125053691ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph'S Healthcare, Inc. CurrentSince Sep 30, 2013 Accepting new patients
St Josephs Medical Group PC CurrentSince Nov 1, 2021 Accepting new patients

Locations

703 Main St
Bldg 400
Paterson, NJ 07503
Phone (973) 754-2054

703 Main St
Rm XG2126
Paterson, NJ 07503
Phone (973) 754-2240

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

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.

Hospital & facility affiliations 1

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": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1073709457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 READ AVE",
            "city": "TUCKAHOE",
            "state": "NY",
            "postal_code": "107073213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-996-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "PUNITA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-19",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125053691",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA09328300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.