Manjusha Gupta, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A102011 Issued in CA

Practice address

1866 N Orange Grove Ave
Suite # 102
Pomona, CA 91767-3031

Phone

(909) 865-0676

Fax

(909) 865-8483

NPI assigned

May 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Chaparral Medical Group, Inc.

  • Dermatology Physician
  • Rancho Cucamonga, CA
  • NPI 1093777666

  Internal Medicine

  Medicare reassignment NPD
• Chaparral Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Pomona, CA
  • NPI 1477733624
  Medicare reassignment NPD
• Chaparral Medical Group Inc.

  • Cardiovascular Disease Physician
  • Upland, CA
  • NPI 1639869605
  NPD
• Chaparral Medical Group, Inc.

  • Dermatology Physician
  • Upland, CA
  • NPI 1558689794
  NPD

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1609077197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1866 N ORANGE GROVE AVE",
            "address_2": "SUITE # 102",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673031",
            "telephone_number": "909-865-0676",
            "fax_number": "909-865-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "MANJUSHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A102011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609077197",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Apollo Avena Gulle, M.D.
• Varuna Gunasekera
• Abigail Gunawan
• Gimha Sudhani Gunawardana, M.D
• Rochelle Rose Gunnarsson, DPT
• Neeraj Gupta, MD
• Gauri Gurumurthy
• Alani Taesha Gutierrez
• Danny Gutierrez
• David Gutierrez

• Internal Medicine Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.