NPIMap

Individual provider Active NPI

Sudeep Gupta, DO

  • Family Medicine Physician
  • Des Moines, IA
National Provider Identifier
1114936713
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03098 Issued in IA
Practice address
1215 Pleasant St Ste 206
Des Moines, IA 50309-1419
Phone
(515) 875-9092
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 03098 IA Primary

Addresses

Primary practice location

1215 Pleasant St Ste 206
Des Moines, IA 50309-1419

Mailing address

PO Box 424
Des Moines, IA 50302-0424
Phone (515) 875-9092

Other identifiers 1

IdentifierTypeStateIssuer
0171769MedicaidIA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sudeepgupta@tic.allscriptsdirect.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100219000524 IA Practitioner - Family Practice 6204970866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Iowa Clinic PCGroup PAC ID 4082513742, 307 clinicians

Practice addresses (Care Compare)

1215 Pleasant St
Suite 206
Des Moines, IA 50309-1419
Phone (515) 875-9100

Hospital & facility affiliations

  • Unitypoint at Home Home health agency, Urbandale, IA, CCN 167148
  • Wesley Life Home Health Home health agency, Urbandale, IA, CCN 167295
  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03098IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Iowa Clinic, PC CurrentSince Jul 8, 2024 Accepting new patients
The Iowa Clinic PC Family Medicine CurrentSince Jul 8, 2024 Accepting new patients

Locations

1215 Pleasant St
Ste 206
Des Moines, IA 50309
Phone (515) 241-5743

1005 Pennsylvania Ave
Ste 102A
Ottumwa, IA 52501
Phone (641) 684-2589

Interoperability endpoints

  • Direct secure messaging: sudeepgupta@tic.allscriptsdirect.net

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 6

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1114936713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 424",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503020424",
            "telephone_number": "515-875-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 PLEASANT ST STE 206",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091419",
            "telephone_number": "515-875-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "SUDEEP",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "03098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0171769",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sudeepgupta@tic.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1215 Pleasant St Ste 206",
            "city": "Des Moines",
            "state": "IA",
            "country_code": "US",
            "postal_code": "503091419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.