Individual provider Active NPI

Raina Sushil Gupta, MD

  • Neurology Physician
  • Fort Myers, FL
National Provider Identifier
1366698482
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
125052600 Issued in IL
Practice address
9110 College Pointe CT
Fort Myers, FL 33919-3244
Phone
(239) 208-2212
Fax
(239) 208-3994
NPI assigned
Aug 8, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD60932592 WA
Neurology Physician 2084N0400X TM00813 TX
Neurology Physician 2084N0400X 58906 TN
Neurology Physician 2084N0400X MD191892 OR
Neurology Physician 2084N0400X 35.135507 OH
Neurology Physician 2084N0400X 297932 NY
Neurology Physician 2084N0400X 19584 NH
Neurology Physician 2084N0400X 15689 ND
Neurology Physician 2084N0400X 83797 GA
Neurology Physician 2084N0400X ME139296 FL
Neurology Physician 2084N0400X 4301116846 MI
Neurology Physician 2084N0400X 125052600 IL Primary

Addresses

Primary practice location

9110 College Pointe CT
Fort Myers, FL 33919-3244

Mailing address

3000 N. Halsted St.
Suite 703
Chicago, IL 60657
Phone (773) 296-6666

Other practice location 1

172 Kinsley St
Nashua, NH 03060-3648
Phone (603) 882-3000

Other practice location 2

3000 N. Halsted St.
Suite 703
Chicago, IL 60657
Phone (773) 296-6666

Other practice location 3

630 Eaton Ave
Hamilton, OH 45013-2767
Phone (513) 867-2000

Other identifiers 1

IdentifierTypeStateIssuer
3118715MedicaidNH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rgupta705005@direct.ketteringhealth.org
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WA, SC, GA4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20111010000591 IL Practitioner - Sleep MedicinePractitioner - Neurology 4385816685 Reassigns benefits to 1 organization
I20190919000371 WA Practitioner - Sleep MedicinePractitioner - Neurology 4385816685 Reassigns benefits to 1 organization
I20200605001456 SC Practitioner - Neurology 4385816685
I20201005002310 GA Practitioner - Neurology 4385816685 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sleep MedicineAlso: Neurology
Education
University of Louisville School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2538 W Patterson Ave
Chicago, IL 60618-6077
Phone (312) 498-8927

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME139296FLMDNeurology Physician
83797GAMDNeurology Physician
125052600ILMDNeurology Physician
58906TNMDNeurology Physician
MD60932592WAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upson County Hospital Inc Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Aug 20, 2019 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. Family Medicine CurrentSince Aug 1, 2020 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. Family Medicine CurrentSince Aug 1, 2020 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Aug 20, 2019 Accepting new patients
Sleepologie Health and Wellness LLC Neurology CurrentSince Mar 21, 2022 Accepting new patients
Piedmont Athens Hospitalist Physicians LLC CurrentSince Aug 1, 2020 Accepting new patients
Upson County Hospital Inc Neurology CurrentSince Jul 1, 2021 Accepting new patients
Piedmont Athens Specialty Care LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Advocate North Side Health Network Past Accepting new patients

Locations

1199 Prince Ave
Athens, GA 30606
Phone (706) 354-3520

35 Collier Rd NW
Ste 635
Atlanta, GA 30309
Phone (404) 367-3000

710 Center St
Columbus, GA 31901
Phone (706) 571-1000

1800 10th Ave
Columbus, GA 31901
Phone (706) 571-1120

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

Interoperability endpoints

  • Direct secure messaging: sleepologie@shawl-il.direct.office.nextgen.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 11

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": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1366698482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N. HALSTED ST.",
            "address_2": "SUITE 703",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-296-6666",
            "fax_number": "713-296-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9110 COLLEGE POINTE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193244",
            "telephone_number": "239-208-2212",
            "fax_number": "239-208-3994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "172 Kinsley St",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030603648",
            "country_code": "US",
            "telephone_number": "603-882-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 N. Halsted St.",
            "address_2": "Suite 703",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60657",
            "country_code": "US",
            "telephone_number": "773-296-6666",
            "fax_number": "713-296-9999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "630 Eaton Ave",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "OH",
            "postal_code": "450132767",
            "country_code": "US",
            "telephone_number": "513-867-2000",
            "fax_number": "513-867-2119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "RAINA",
        "middle_name": "SUSHIL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-08",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60932592",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "TM00813",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "58906",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD191892",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "35.135507",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "297932",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NH",
            "license": "19584",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ND",
            "license": "15689",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "83797",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME139296",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301116846",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "125052600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3118715",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgupta705005@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "630 Eaton Ave",
            "city": "Hamilton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450132767",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "630 Eaton Ave",
            "city": "Hamilton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450132767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.