Anjali Gupta

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

ME136879 Issued in FL

Practice address

1320 S Bay St
Eustis, FL 32726-5551

Phone

(352) 530-9557

Fax

(352) 602-7149

NPI assigned

Jul 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Forever Care Home Visiting Physicians Inc

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1851865364
  NPD
• Pennachio & Fishman M.D., P.a.

  • Ophthalmology Physician
  • Clermont, FL
  • NPI 1407067838
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1760414122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 S BAY ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327265551",
            "telephone_number": "352-530-9557",
            "fax_number": "352-602-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 S BAY ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327265551",
            "telephone_number": "352-530-9557",
            "fax_number": "352-602-7149"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "481 N SR 434",
            "address_purpose": "LOCATION",
            "city": "Altamonte Springs",
            "state": "FL",
            "postal_code": "327142181",
            "country_code": "US",
            "telephone_number": "407-765-1313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "ANJALI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "IL",
            "license": "036129588",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IA",
            "license": "37462",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "PA",
            "license": "MD063886L",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "FL",
            "license": "ME136879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "70640",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME136879",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016869060001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lawrence Ezra Green, M.D.
• Jay Norman Grefe Jr.
• Shatahvia Grier
• Miranda Gue
• Jalaneia Renee Guions
• Daniel Gutherman
• Chanelle Gutierrez
• Andrea Elaine Hall, SLP
• Yshheyna Hamilla, M.A., LMHC
• Janean Hamilton, RN, AP

• Addiction Medicine (Psychiatry & Neurology) Physician in Eustis, FL
• Providers in Eustis, FL by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.

Verify at the official NPI Registry.