Individual provider Active NPI

Ashutosh Gupta, MD

  • Nephrology Physician
  • Chicago, IL
National Provider Identifier
1528065646
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036052219 Issued in IL
Practice address
7531 S Stony Island Ave
Suite 158 & 160
Chicago, IL 60649-3954
Phone
(773) 947-2289
Fax
(773) 493-1430
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036052219 IL Primary

Addresses

Primary practice location

7531 S Stony Island Ave
Suite 158 & 160
Chicago, IL 60649-3954

Mailing address

855 Madison St
Oak Park, IL 60302-4420
Phone (708) 492-4077

Other identifiers 1

IdentifierTypeStateIssuer
036052219MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036052219ILMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Park Hospital Foundation Current Accepting new patients

Locations

7531 S Stony Island Ave
Ste 158160
Chicago, IL 60649
Phone (773) 947-2289

7531 S Stony Island Ave
Ste 158
Chicago, IL 60649
Phone (773) 947-2289

Interoperability endpoints

  • Direct secure messaging: ashtoshgupta@jph.medalliesdirect.net

Organizations & group practices 1

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1528065646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 MADISON ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024420",
            "telephone_number": "708-492-4077",
            "fax_number": "708-386-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7531 S STONY ISLAND AVE",
            "address_2": "SUITE 158 & 160",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493954",
            "telephone_number": "773-947-2289",
            "fax_number": "773-493-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "ASHUTOSH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036052219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052219",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.