Individual provider Active NPI

Charul Gupta

  • Physical Therapist
  • Fremont, CA
National Provider Identifier
1164272357
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
304855 Issued in CA
Practice address
3905 Beacon Ave
Fremont, CA 94538-1405
Phone
(510) 608-3730
NPI assigned
Mar 22, 2024
Last updated
Mar 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 304855 CA Primary

Addresses

Primary practice location

3905 Beacon Ave
Fremont, CA 94538-1405

Mailing address

3905 Beacon Ave
Fremont, CA 94538-1405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240905001219 CA Practitioner - Physical Therapist in Private Practice 0547700569 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Select Cal Physical Therapy PCGroup PAC ID 4789070699, 162 clinicians

Practice addresses (Care Compare)

3905 Beacon Ave
Fremont, CA 94538-1405
Phone (510) 608-3730

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
304855CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Select Cal Physical Therapy PC Physical Therapist Current Accepting new patients
Select Cal Physical Therapy PC Physical Therapist CurrentSince Jul 22, 2024 Accepting new patients
Select Cal Physical Therapy PC CurrentSince Jul 22, 2024 Accepting new patients

Locations

1470 Civic Ct
Ste 320
Concord, CA 94520
Phone (925) 326-2211

3905 Beacon Ave
Fremont, CA 94538
Phone (510) 608-3730

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1164272357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 BEACON AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 BEACON AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381405",
            "telephone_number": "510-608-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "CHARUL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "304855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.