Active NPI
Sujan Gautam, NP
- Family Nurse Practitioner
- San Francisco, CA
National Provider Identifier
1790499630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95023796
- Practice address
- 900 Folsom St Apt 414
San Francisco, CA 94107-2170 - Phone
- (318) 243-5254
- NPI assigned
- Jan 5, 2023
- Last updated
- Jan 5, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95023796 | CA | Primary |
Addresses
Primary practice location
900 Folsom St Apt 414
San Francisco, CA 94107-2170
Mailing address
900 Folsom St Apt 414
San Francisco, CA 94107-2170
Phone (318) 243-5254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95023796 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supra Cares Inc | Current | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672876800000",
"number": "1790499630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 FOLSOM ST APT 414",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941072170",
"telephone_number": "318-243-5254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 FOLSOM ST APT 414",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941072170",
"telephone_number": "318-243-5254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAUTAM",
"first_name": "SUJAN",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-05",
"last_updated": "2023-01-05",
"certification_date": "2023-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95023796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.