Veena Kawatra Gupta, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036065879 Issued in IL

Practice address

3307 Broadway St
Ste 140
Mount Vernon, IL 62864-2347

Phone

(618) 244-7200

Fax

(618) 244-7274

NPI assigned

Jun 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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.

• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807

  Family Medicine, IL

  Medicare reassignment NPD
• Physician Rural Health Clinic of Jefferson County

  • Rural Health Clinic/Center
  • Mount Vernon, IL
  • NPI 1649283870
  NPD (past) Authorized official

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1790713899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3307 BROADWAY",
            "address_2": "STE 140",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642347",
            "telephone_number": "618-244-7200",
            "fax_number": "618-244-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3307 BROADWAY ST",
            "address_2": "STE 140",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642347",
            "telephone_number": "618-244-7200",
            "fax_number": "618-244-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "VEENA",
        "middle_name": "KAWATRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036065879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036065879",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Good Samaritan Regional Health Center
• Stephanie Rae Green
• Jody Grubbs, MHP
• Vicente A Gueco, MD
• Anil Gupta, M.D.
• Shelby Guthrie, FNP
• Susan Guthrie, MS, CCC-SLP
• Jamie Hackmann, MSW, CADC
• Braedon Haertling, PA-C
• Devin D Haertling, PA-C

• All providers in Mount Vernon, IL
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.