Individual provider Active NPI

Preeti Gupta

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1417698341
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
V7221 Issued in TX
Practice address
11930 W US Highway 90 Ste 110
San Antonio, TX 78245-9613
Phone
(210) 431-6255
NPI assigned
Apr 5, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X V7221 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

11930 W US Highway 90 Ste 110
San Antonio, TX 78245-9613

Mailing address

11930 W US Highway 90 Ste 110
San Antonio, TX 78245-9613

Other practice location 1

820 S Wood St Ste 100
Chicago, IL 60612-4325
Phone (312) 996-2933

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20251023001409 TX Practitioner - Pediatric Medicine 5698156388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3066 E Commerce St
San Antonio, TX 78220-1013

3419 Deep Wood Dr
Crystal Lake, IL 60012-1024

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
V7221TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barrio Comprehensive Family Health Care Center, Inc. CurrentSince Aug 28, 2025 Accepting new patients
Barrio Comprehensive Family Health Care Center, Inc. Current Accepting new patients
Barrio Comprehensive Family Health Care Center, Inc. CurrentSince Aug 28, 2025 Accepting new patients

Locations

1102 Barclay St
San Antonio, TX 78207
Phone (210) 434-0513

14625 Huebner Rd
San Antonio, TX 78230

11930 W US Highway 90
Ste 110
San Antonio, TX 78245
Phone (210) 431-6255

3066 E Commerce St
San Antonio, TX 78220
Phone (210) 233-7062

Interoperability endpoints

  • Direct secure messaging: pgupta134799@uihealth.direct-ci.com

Organizations & group practices 3

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": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1417698341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11930 W US HIGHWAY 90 STE 110",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782459613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 W US HIGHWAY 90 STE 110",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782459613",
            "telephone_number": "210-431-6255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 S Wood St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606124325",
            "country_code": "US",
            "telephone_number": "312-996-2933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "PREETI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "V7221",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.