Active NPI
Brijendra K Gupta, M.D.
- Nephrology Physician
- Jacksonville, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- ME93901
- Practice address
- 2585 Herschel St
Jacksonville, FL 32204-4557 - Phone
- (904) 388-2678
- Fax
- (904) 388-6776
- NPI assigned
- Feb 23, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | ME93901 | FL | Primary |
| Specialist | 174400000X | ME93901 | FL |
Addresses
Primary practice location
2585 Herschel St
Jacksonville, FL 32204-4557
Mailing address
2585 Herschel St
Jacksonville, FL 32204-4557
Phone (904) 388-2678
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 273423100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20050825000062 | FL | Practitioner - Nephrology | 6608807151 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Florida Kidney Physicians LLC
Practice addresses (Care Compare)
2585 Herschel St
Jacksonville, FL 32204-4557
Phone (904) 388-2678
Hospital & facility affiliations
- First Coast Dialysis
- Fresenius Kidney Care Orange Park North
- Baptist Medical Center Beaches
- HCA Florida Memorial Hospital
- Baptist Health Medical Center - Jacksonville
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 76.86
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles (4 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Kidney Physicians, LLC | Nephrology | Current | Accepting new patients |
| Florida Kidney Physicians , LLC | Nephrology | Current | Accepting new patients |
| Advanced Nutrition Consultants Inc | Past | Accepting new patients | |
| Pee Dee Nephrology LLP | Nephrology | Past | Accepting new patients |
Locations
1150 N 35th Ave
Ste 620
Hollywood, FL 33021
Phone (954) 612-8173
5730 Bowden Rd
Ste 110
Jacksonville, FL 32216
Phone (904) 419-0273
1201 Monument Rd
Ste 301
Jacksonville, FL 32225
Phone (800) 636-1701
2585 Herschel St
Jacksonville, FL 32204
19056 NE 29th Ave
Miami, FL 33180
Phone (305) 354-4558
12662 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 910-8708
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4
- brijendra.gupta.1@15644.direct.athenahealth.com
Organizations & group practices 4
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.
-
- Nephrology Physician
- Temple Terrace, FL
- NPI 1760831564
FL, Nephrology
-
- Renal Nutrition Registered Dietitian
- Rock Hill, SC
- NPI 1700204526
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Orange Park, FL
- NPI 1275980377
Dialysis facility
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Jacksonville, FL
- NPI 1699887430
Dialysis facility
-
- General Acute Care Hospital
- Jacksonville Beach, FL
- NPI 1821155912
Hospital
-
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1578620449
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624924800000",
"number": "1639145352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2585 HERSCHEL ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322044557",
"telephone_number": "904-388-2678",
"fax_number": "904-388-6776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2585 HERSCHEL ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322044557",
"telephone_number": "904-388-2678",
"fax_number": "904-388-6776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "BRIJENDRA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2021-06-29",
"certification_date": "2021-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "FL",
"license": "ME93901",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "ME93901",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273423100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.