Active NPI
Atul Gupta, MD
- Family Medicine Physician
- Portland, OR
National Provider Identifier
1609220250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD192425
- Practice address
- 703 NE Hancock St
Portland, OR 97212-3955 - Phone
- (503) 230-9875
- Fax
- (503) 331-3441
- NPI assigned
- Apr 20, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD192425 | OR | Primary |
Addresses
Primary practice location
703 NE Hancock St
Portland, OR 97212-3955
Mailing address
1776 SW Madison St
Portland, OR 97205-1715
Phone (503) 224-1044
Other practice location 1
12360 E Burnside St
Portland, OR 97233-1042
Phone (971) 279-4800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500786553 | Medicaid | OR | |
| 2167900 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD192425 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1609220250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 SW MADISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051715",
"telephone_number": "503-224-1044",
"fax_number": "503-621-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 NE HANCOCK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972123955",
"telephone_number": "503-230-9875",
"fax_number": "503-331-3441"
}
],
"practiceLocations": [
{
"address_1": "12360 E Burnside St",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972331042",
"country_code": "US",
"telephone_number": "971-279-4800",
"fax_number": "971-279-2051",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUPTA",
"first_name": "ATUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-20",
"last_updated": "2022-05-12",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD192425",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500786553",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2167900",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; 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.