Active NPI
Shubham Gupta, M.D
- Internal Medicine Physician
- Dallas, TX
National Provider Identifier
1619067147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01061603A
- Practice address
- 4500 South Lancaster Road
VA Medical Center
Dallas, TX 75216 - Phone
- (214) 857-1580
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01061603A | IN | Primary |
| Internal Medicine Physician | 207R00000X | 35.087590 | OH |
Addresses
Primary practice location
4500 South Lancaster Road
VA Medical Center
Dallas, TX 75216
Mailing address
4500 S Lancaster Road
Veterans Affairs Medical Center (111K)
Dallas, TX 75216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130528000515 | TX | Order and Referring Only - Internal Medicine | 0648418947 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01061603A | IN | MD | Internal Medicine Physician |
| 35.087590 | OH | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304467200000",
"number": "1619067147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 S LANCASTER ROAD",
"address_2": "VETERANS AFFAIRS MEDICAL CENTER (111K)",
"city": "DALLAS",
"state": "TX",
"postal_code": "75216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 SOUTH LANCASTER ROAD",
"address_2": "VA MEDICAL CENTER",
"city": "DALLAS",
"state": "TX",
"postal_code": "75216",
"telephone_number": "214-857-1580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "SHUBHAM",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2011-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01061603A",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35.087590",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; 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.