NPIMap

Individual provider Active NPI

Sanjiv Gupta, MD

  • Internal Medicine Physician
  • Grayson, KY
National Provider Identifier
1487761243
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
32686 Issued in KY
Practice address
300 State Highway 1947
Grayson, KY 41143
Phone
(606) 474-2200
Fax
(606) 474-2205
NPI assigned
Aug 25, 2006
Reactivated
Jul 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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 32686 KY Primary

Addresses

Primary practice location

300 State Highway 1947
Grayson, KY 41143

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2016446MedicaidOH
64326861MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20041110000373 KY Practitioner - Family PracticePractitioner - Internal Medicine 4688637614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Therapy and Health Centers IncGroup PAC ID 7416859574, shared by 6 NPIs, 263 clinicians

Practice addresses (Care Compare)

710 N Carol Malone Boulevard
Suite a
Grayson, KY 41143-1126
Phone (606) 474-0157

7700 Ohio River Rd
Suite B
Wheelersburg, OH 45694-1653
Phone (740) 574-4616

PO Box
Suite 1620
Grayson, KY 41143-5620
Phone (606) 474-2200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.66 of 100Reported as individual
Quality
78.58
Improvement activities
40
Cost
68.09

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanjiv Gupta M.D. P.S.C. Internal Medicine CurrentSince Mar 13, 2000 Accepting new patients
Sanjiv Gupta, M.D., P.S.C. CurrentSince Mar 13, 2000 Accepting new patients
Grayson Health Park Past Accepting new patients
Sanjiv Gupta M.D. P.S.C. Past Accepting new patients

Locations

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

708 N Carol Malone Blvd
Grayson, KY 41143
Phone (606) 474-2200

Organizations & group practices 4

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 4

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1487761243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1620",
            "address_2": "300 STATE HWY 1947",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "41143",
            "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 STATE HIGHWAY 1947",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "41143",
            "telephone_number": "606-474-2200",
            "fax_number": "606-474-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "SANJIV",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2012-09-07",
        "deactivation_date": "2007-03-21",
        "reactivation_date": "2007-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "32686",
            "primary": true
        }
    ],
    "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

Verify at the official NPI Registry.