Active NPI
Anjali Gupta, MD
- Nephrology Physician
- Roseburg, OR
National Provider Identifier
1104074715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- MD61204532
- Practice address
- 2460 NW Stewart Pkwy
Suite 102
Roseburg, OR 97471-1516 - Phone
- (541) 677-2494
- NPI assigned
- Sep 8, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD61204532 | WA | |
| Nephrology Physician | 207RN0300X | MD61204532 | WA | Primary |
| Nephrology Physician | 207RN0300X | MD167029 | OR | |
| Hospitalist Physician | 208M00000X | 61-003355 | NY |
Addresses
Primary practice location
2460 NW Stewart Pkwy
Suite 102
Roseburg, OR 97471-1516
Mailing address
2460 NW Stewart Pkwy
Suite 102
Roseburg, OR 97471-1516
Other practice location 1
505 NE 87th Ave Ste 460
Vancouver, WA 98664-1965
Phone (360) 514-2470
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03126478 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR, WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
505 NE 87TH Ave
Vancouver, WA 98664-1965
Phone (360) 514-6390
Hospital & facility affiliations
- Peacehealth Southwest Medical Cente
- Legacy Salmon Creek Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61-003355 | NY | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Current | Accepting new patients | |
| Centennial Medical Group Inc. | Hospitalist | Current | Accepting new patients |
| Centennial Medical Group Inc. | Past | Accepting new patients |
Locations
201 NW Medical Loop
Ste 190
Roseburg, OR 97471
Phone (541) 644-4319
2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611
2460 NW Stewart Pkwy
Ste 102
Roseburg, OR 97471
Phone (541) 464-6258
505 NE 87th Ave
Ste 301
Vancouver, WA 98664
Phone (360) 514-1854
1115 SE 164th Ave
Dept 364
Vancouver, WA 98683
Phone (360) 735-8100
505 NE 87th Ave
Ste 460
Vancouver, WA 98664
Phone (360) 514-2470
Interoperability endpoints
- agupta541493@direct.peacehealth.org
Organizations & group practices 3
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.
-
- Surgery Physician
- Vancouver, WA
- NPI 1609061969
-
- Cardiovascular Disease Physician
- Roseburg, OR
- NPI 1033365135
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Vancouver, WA
- NPI 1700809829
-
- General Acute Care Hospital
- Vancouver, WA
- NPI 1134178999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636502400000",
"number": "1104074715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2460 NW STEWART PKWY",
"address_2": "SUITE 102",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974711516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2460 NW STEWART PKWY",
"address_2": "SUITE 102",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974711516",
"telephone_number": "541-677-2494"
}
],
"practiceLocations": [
{
"address_1": "505 NE 87th Ave Ste 460",
"address_purpose": "LOCATION",
"city": "Vancouver",
"state": "WA",
"postal_code": "986641965",
"country_code": "US",
"telephone_number": "360-514-2470",
"fax_number": "360-514-7624",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUPTA",
"first_name": "ANJALI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-08",
"last_updated": "2021-11-10",
"certification_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD61204532",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "WA",
"license": "MD61204532",
"primary": true
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "OR",
"license": "MD167029",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "NY",
"license": "61-003355",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03126478",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.