NPIMap

Organization Active NPI

Sanjiv Gupta M.D. P.S.C.

  • Internal Medicine Physician
  • Grayson, KY
National Provider Identifier
1477562536
Registry record updated Apr 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
32686 Issued in KY
Legal business name
SANJIV GUPTA M.D. P.S.C.
Practice address
300 St Hwy 1947
Suite a
Grayson, KY 41143-1947
Phone
(606) 474-2200
Fax
(606) 474-2205
NPI assigned
Aug 7, 2006
Reactivated
Nov 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2020

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

Authorized official

Name
Sanjiv Gupta, MDNPI 1487761243
Title
President/Owner
Phone
(606) 474-2200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 32686 KY Primary
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X
Durable Medical Equipment & Medical Supplies 332B00000X 32686 KY

Addresses

Primary practice location

300 St Hwy 1947
Suite a
Grayson, KY 41143-1947

Mailing address

PO Box 1620
300 St Hwy 1947
Grayson, KY 41143-5620
Phone (606) 474-2200

Other practice location 1

101 Ashland Dr
Ashland, KY 41101-7001
Phone (606) 324-1966

Other practice location 2

101 Ashland Dr
Ashland, KY 41101-7001
Phone (606) 324-1996

Other identifiers 2

IdentifierTypeStateIssuer
2016446MedicaidOH
64326861MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041110000275 KY Part B Supplier - Clinic/Group Practice 7012970031 Receives reassigned benefits from 2 practitioners
Practice locations: Grayson, KY; Ashland, KY
O20110329000468 KY DME Supplier - Physician - Family Practice 7012970031 Practice locations: Grayson, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588032000000",
    "number": "1477562536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1620",
            "address_2": "300 ST HWY 1947",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411435620",
            "telephone_number": "606-474-2200",
            "fax_number": "606-474-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 ST HWY 1947",
            "address_2": "SUITE A",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431947",
            "telephone_number": "606-474-2200",
            "fax_number": "606-474-2205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Ashland Dr",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "KY",
            "postal_code": "411017001",
            "country_code": "US",
            "telephone_number": "606-324-1966",
            "fax_number": "606-833-2430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Ashland Dr",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "KY",
            "postal_code": "411017001",
            "country_code": "US",
            "telephone_number": "606-324-1996",
            "fax_number": "606-833-2430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANJIV GUPTA M.D. P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "deactivation_date": "2007-07-02",
        "reactivation_date": "2007-11-09",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "SANJIV",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "606-474-2200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "32686",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "32686",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016446",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64326861",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.