Individual provider Active NPI

Shashank Gupta, MD

  • Student in an Organized Health Care Education/Training Program
  • Loma Linda, CA
National Provider Identifier
1336728740
Registry record updated Apr 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
11234 Anderson St
Gme Office Westerly Suite 'C'
Loma Linda, CA 92354-2804
Phone
(909) 558-4074
NPI assigned
Apr 4, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

11234 Anderson St
Gme Office Westerly Suite 'C'
Loma Linda, CA 92354-2804

Mailing address

11234 Anderson St
Gme Office Westerly Suite 'C'
Loma Linda, CA 92354-2804
Phone (909) 558-4074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250106003642 CA Practitioner - Internal Medicine 6406384346 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cassidy Medical Group Inc. Current Accepting new patients
Beaver Medical Group P C CurrentSince Jan 1, 2025 Accepting new patients
Centers for Family Medicine GP Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 30, 2025 Accepting new patients
Beaver Medical Group P C CurrentSince Jan 1, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 30, 2025 Accepting new patients

Locations

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

4867 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-7920

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1600 E Citrus Ave
Ste A
Redlands, CA 92374
Phone (909) 294-3682

2 W Fern Ave
Redlands, CA 92373
Phone (909) 335-4137

145 Thunder Dr
Vista, CA 92083
Phone (760) 630-5487

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1617494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617494400000",
    "number": "1336728740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "GME OFFICE WESTERLY SUITE 'C'",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "GME OFFICE WESTERLY SUITE 'C'",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "SHASHANK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-04",
        "last_updated": "2021-04-04",
        "certification_date": "2021-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.