NPIMap

Individual provider Active NPI

Raghav Gupta, MD

  • Interventional Cardiology Physician
  • Jacksonville, FL
National Provider Identifier
1629118740
Registry record updated Dec 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
ME158258 Issued in FL
Practice address
836 Prudential Dr Ste 1700
Jacksonville, FL 32207-8344
Phone
(904) 398-0125
Fax
(904) 398-1832
NPI assigned
Feb 7, 2007
Last updated
Dec 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME158258 FL
Interventional Cardiology Physician 207RI0011X 25029 OK
Interventional Cardiology Physician 207RI0011X ME158258 FL Primary

Addresses

Primary practice location

836 Prudential Dr Ste 1700
Jacksonville, FL 32207-8344

Mailing address

PO Box 746652
Atlanta, GA 30374-6652
Phone (904) 720-0599

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rgupta@direct.okheart.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230105001159 FL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 4981847183 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Cardiology, Inc.Group PAC ID 2466614581, 98 clinicians

Practice addresses (Care Compare)

836 Prudential Dr
Suite 1700
Jacksonville, FL 32207-8344
Phone (904) 398-0125

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting25
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ecg Associates of Jacksonville P a CurrentSince Jan 6, 2024 Accepting new patients
Baptist Cardiology, Inc. Cardiovascular Disease CurrentSince Jan 16, 2023 Accepting new patients
Kenneth L Gwinn MD PC PastSince Dec 21, 2004 Accepting new patients

Locations

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

836 Prudential Dr
Ste 1700
Jacksonville, FL 32207
Phone (904) 398-0125

Interoperability endpoints

  • Direct secure messaging: rgupta@direct.okheart.com
  • Direct secure messaging: rgupta134504@baptisthealthsystemjacksonville.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1629118740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746652",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746652",
            "telephone_number": "904-720-0599",
            "fax_number": "904-376-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 PRUDENTIAL DR STE 1700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078344",
            "telephone_number": "904-398-0125",
            "fax_number": "904-398-1832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "RAGHAV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME158258",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OK",
            "license": "25029",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME158258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgupta@direct.okheart.com",
            "affiliation": "N",
            "endpointDescription": "Direct Addres",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4050 W Memorial Rd",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731208382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.