Active NPI
Supreet Ghumman
- Student in an Organized Health Care Education/Training Program
- San Antonio, TX
National Provider Identifier
1619723954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 7615 Kennedy HL
San Antonio, TX 78235-4437 - Phone
- (210) 890-4243
- Fax
- (210) 890-4243
- NPI assigned
- Apr 26, 2024
- Last updated
- Jun 11, 2026
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | Primary |
Addresses
Primary practice location
7615 Kennedy HL
San Antonio, TX 78235-4437
Mailing address
27809 121St PL SE
Kent, WA 98030-8537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- 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 |
|---|---|---|---|---|
| I20240627002989 | WA | Order and Referring Only - Family Practice | 4688118912 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OL61555072 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781136000000",
"number": "1619723954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27809 121ST PL SE",
"city": "KENT",
"state": "WA",
"postal_code": "980308537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7615 KENNEDY HL",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782354437",
"telephone_number": "210-890-4243",
"fax_number": "210-890-4243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHUMMAN",
"first_name": "SUPREET",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-26",
"last_updated": "2026-06-11",
"certification_date": "2026-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; 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.