Southern Vascular of Panama City PLLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

SOUTHERN VASCULAR OF PANAMA CITY PLLC

Practice address

1399 Jenks Ave # 12
Panama City, FL 32401-2442

Phone

(850) 532-6303

Fax

(850) 307-5402

NPI assigned

Sep 3, 2013

Organization subpart

No

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

Authorized official

Name

Ashish K Gupta, MDNPI 1942390729

Title

Physician/Owner

Phone

(850) 896-1696

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GICECA

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashish K Gupta, MD

  • Vascular Surgery Physician
  • Panama City, FL
  • NPI 1942390729
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1699109181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1399 JENKS AVE # 12",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012442",
            "telephone_number": "850-532-6303",
            "fax_number": "850-307-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1399 JENKS AVE # 12",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012442",
            "telephone_number": "850-532-6303",
            "fax_number": "850-307-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN VASCULAR OF PANAMA CITY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "ASHISH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "850-896-1696",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "004XT",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DU2333",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Vascular Surgery Physician in Panama City, FL
• Providers in Panama City, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.