Individual provider Active NPI

Pooja Gupta, MD

  • Pulmonary Disease Physician
  • Memphis, TN
National Provider Identifier
1205044062
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
66968 Issued in TN
Practice address
880 Madison Ave
Memphis, TN 38103-3409
Phone
(901) 545-6969
Fax
(901) 545-4748
NPI assigned
May 17, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2006013138 MO
Pulmonary Disease Physician 207RP1001X 6462 NE
Pulmonary Disease Physician 207RP1001X 66968 TN Primary

Addresses

Primary practice location

880 Madison Ave
Memphis, TN 38103-3409

Mailing address

900 Main St Ste 630
Peoria, IL 61602-5024
Phone (309) 672-4433

Other identifiers 1

IdentifierTypeStateIssuer
036123061OtherILLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, TN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110223001038 IL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 1052592029 Reassigns benefits to 3 organizations
I20230130001717 TN Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 1052592029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Regional One Physicians IncGroup PAC ID 5698993418, 314 clinicians

Practice addresses (Care Compare)

880 Madison Ave
Memphis, TN 38103-3409
Phone (901) 545-6969

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006013138MOMDInternal Medicine Physician
6462NEMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois Current Accepting new patients
Ut Regional One Physicians Inc CurrentSince Feb 1, 2023 Accepting new patients
Ut Regional One Physicians Inc Internal Medicine CurrentSince Feb 1, 2023 Accepting new patients
Cook County Internal Medicine CurrentSince Nov 10, 2010 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2015 Accepting new patients
Cook County CurrentSince Nov 10, 2010 Accepting new patients
Cook County Current Accepting new patients
Proctor Health Systems Internal Medicine CurrentSince Feb 5, 2018 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2015 Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

900 Main St
Ste 630
Peoria, IL 61602
Phone (309) 627-4433

815 Main St
Ste A1
Peoria, IL 61602

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

880 Madison Ave
Memphis, TN 38103
Phone (901) 515-3500

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

Organizations & group practices 9

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": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1205044062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MAIN ST STE 630",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616025024",
            "telephone_number": "309-672-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033409",
            "telephone_number": "901-545-6969",
            "fax_number": "901-545-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "POOJA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2006013138",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NE",
            "license": "6462",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TN",
            "license": "66968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036123061",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.