NPIMap

Individual provider Active NPI

Mohina Gupta, MD

  • Internal Medicine Physician
  • Libertyville, IL
National Provider Identifier
1174578843
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036103173 Issued in IL
Practice address
1870 W Winchester Rd Ste 248
Libertyville, IL 60048-5360
Phone
(847) 281-8902
Fax
(847) 281-8906
NPI assigned
May 23, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036103173 IL Primary

Addresses

Primary practice location

1870 W Winchester Rd Ste 248
Libertyville, IL 60048-5360

Mailing address

1870 W Winchester Rd Ste 248
Libertyville, IL 60048-5360
Phone (847) 281-8902

Other identifiers 3

IdentifierTypeStateIssuer
336063864OtherILCONTROLLED SUBSTANCE
036103173MedicaidIL
036103173OtherILPROFESSIONAL LICENSE

Other names 1

  • Dr. Mohina Gupta Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20070619000241 IL Practitioner - Internal Medicine 1052410990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1870 W Winchester Rd
Suite 248
Libertyville, IL 60048-5360
Phone (847) 281-8902

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036103173ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Suburban Health Care LTD Internal Medicine CurrentSince Aug 15, 2001 Accepting new patients
North Suburban Healthcare LTD Internal Medicine Current Accepting new patients

Locations

150 W Half Day Rd
Ste 105
Buffalo Grove, IL 60089
Phone (847) 793-9800

1870 W Winchester Rd
Ste 248
Libertyville, IL 60048
Phone (847) 281-8902

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

Hospital & facility affiliations 11

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1174578843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 W WINCHESTER RD STE 248",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485360",
            "telephone_number": "847-281-8902",
            "fax_number": "847-281-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 W WINCHESTER RD STE 248",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485360",
            "telephone_number": "847-281-8902",
            "fax_number": "847-281-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "MOHINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2023-03-07",
        "certification_date": "2021-12-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036103173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE",
            "identifier": "336063864",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036103173",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "036103173",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOHINA",
            "last_name": "GUPTA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.