Individual provider Active NPI

Kripa Gautam, MD

  • Internal Medicine Physician
  • Worcester, MA
National Provider Identifier
1447712815
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
294812 Issued in MA
Practice address
5 Neponset St
Worcester, MA 01606-2714
Phone
(508) 595-2300
Fax
(508) 535-1523
NPI assigned
Apr 3, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 294812 MA Primary

Addresses

Primary practice location

5 Neponset St
Worcester, MA 01606-2714

Mailing address

5 Neponset St
Worcester, MA 01606-2714
Phone (508) 595-2300

Other identifiers 1

IdentifierTypeStateIssuer
110191747AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20221110000398 MA Practitioner - Internal Medicine 8729455340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reliant Medical Group IncGroup PAC ID 5597755322, 638 clinicians

Practice addresses (Care Compare)

5 Neponset St
Worcesteer, MA 01606-2714
Phone (508) 595-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
294812MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc Internal Medicine CurrentSince Oct 10, 2022 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

5 Neponset St
Fl 12
Worcester, MA 01606
Phone (508) 852-6175

Interoperability endpoints

  • Direct secure messaging: kripa.gautam.npi1447712815.reliant@direct.optumcare.masshiway.net
  • Direct secure messaging: kripa.gautam.1@3792.direct.athenahealth.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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1447712815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 NEPONSET ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062714",
            "telephone_number": "508-595-2300",
            "fax_number": "508-535-1523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 NEPONSET ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062714",
            "telephone_number": "508-595-2300",
            "fax_number": "508-535-1523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTAM",
        "first_name": "KRIPA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "294812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110191747A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.