NPIMap

Individual provider Active NPI

Supriyo U Ghosh, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Camp Hill, PA
National Provider Identifier
1366430019
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
MD0423865 Issued in PA
Practice address
888 Poplar Church Rd
Camp Hill, PA 17011-2205
Phone
(717) 724-2126
Fax
(717) 724-2132
NPI assigned
Oct 7, 2005
Last updated
Oct 16, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD0423865 PA Primary

Addresses

Primary practice location

888 Poplar Church Rd
Camp Hill, PA 17011-2205

Mailing address

888 Poplar Church Rd
Camp Hill, PA 17011-2205
Phone (717) 724-2126

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20040604000084 PA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 6305828138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Azizkhan Internal Medicine AssociatesGroup PAC ID 8527040351, 3 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

888 Poplar Church Rd
Camp Hill, PA 17011-2205
Phone 7177242126408

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0423865PAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Windber Hospital, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sghosh@aima.medentdirect.com

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 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192492800000",
    "number": "1366430019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 POPLAR CHURCH RD",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112205",
            "telephone_number": "717-724-2126",
            "fax_number": "717-724-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 POPLAR CHURCH RD",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112205",
            "telephone_number": "717-724-2126",
            "fax_number": "717-724-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOSH",
        "first_name": "SUPRIYO",
        "middle_name": "U",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2007-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "MD0423865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camp Hill, PA

Sources for this page

Verify at the official NPI Registry.