NPIMap

Individual provider Active NPI

Mini Gupta, M.D.

  • Family Medicine Physician
  • Haddon Township, NJ
National Provider Identifier
1528117389
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA07795500 Issued in NJ
Practice address
216 Haddon Ave
Suite 100
Haddon Township, NJ 08108-2809
Phone
(856) 854-6600
Fax
(856) 854-6610
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA07795500 NJ Primary

Addresses

Primary practice location

216 Haddon Ave
Suite 100
Haddon Township, NJ 08108-2809

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other identifiers 1

IdentifierTypeStateIssuer
0091294MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgupta166852@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20051104000608 NJ Practitioner - Family Practice 8325000409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07795500NJMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA Family Medicine Current Accepting new patients
Virtua Medical Group, PA CurrentSince Nov 1, 2020 Accepting new patients
Virtua Our Lady of Lourdes Hospital Inc Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1600 Haddon Ave
Camden, NJ 08103
Phone (609) 757-3500

141 Route 70 E
Ste E
Marlton, NJ 08053
Phone (856) 985-7373

303 Lippincott Dr
Marlton, NJ 08053

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

110 Marter Ave
Ste 503
Moorestown, NJ 08057
Phone (856) 608-8840

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

200 Campbell Dr
Ste 102
Willingboro, NJ 08046
Phone (609) 877-4545

Interoperability endpoints

  • Direct secure messaging: mgupta166852@directvirtua.org

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.

Hospital & facility affiliations 5

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": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1528117389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 HADDON AVE",
            "address_2": "SUITE 100",
            "city": "HADDON TOWNSHIP",
            "state": "NJ",
            "postal_code": "081082809",
            "telephone_number": "856-854-6600",
            "fax_number": "856-854-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "MINI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA07795500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0091294",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgupta166852@directvirtua.org",
            "affiliation": "N",
            "address_1": "216 Haddon Ave",
            "address_2": "Suite 100",
            "city": "Haddon Township",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "081082809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Haddon Township, NJ

Sources for this page

Verify at the official NPI Registry.