NPIMap

Individual provider Active NPI

Neelum Gupta, M.D.

  • Internal Medicine Physician
  • Berkley, MI
National Provider Identifier
1811901309
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301066816 Issued in MI
Practice address
1695 W 12 Mile Rd
Suite 200
Berkley, MI 48072-2182
Phone
(248) 548-9090
Fax
(248) 548-8462
NPI assigned
Jul 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301066816 MI Primary

Addresses

Primary practice location

1695 W 12 Mile Rd
Suite 200
Berkley, MI 48072-2182

Mailing address

1695 W 12 Mile Rd
Suite 200
Berkley, MI 48072-2182
Phone (248) 548-9090

Other identifiers 3

IdentifierTypeStateIssuer
1811901309MedicaidMI
0F37128OtherMIBCBSM
4715799MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041015000221 MI Practitioner - Internal Medicine 3072573823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Associated Physicians Group PLCGroup PAC ID 7113209875, 2 clinicians

Practice addresses (Care Compare)

1695 12 Mile Rd
Suite 200
Berkley, MI 48072-2100
Phone (248) 548-9090

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301066816MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Physicians Group, PC CurrentSince Aug 1, 2011 Accepting new patients
Associated Physicians Group PLC Internal Medicine CurrentSince Dec 10, 2016 Accepting new patients
Madison Medical P.C Past Accepting new patients
Madisonville Medical Corp. Past Accepting new patients

Locations

2905 W 12 Mile Rd
Berkley, MI 48072
Phone (248) 541-0770

1695 12 Mile Rd
Ste 200
Berkley, MI 48072
Phone (248) 545-8690

Interoperability endpoints

  • Direct secure messaging: ngupta1236356@epic00.shdirect.org

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1811901309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 W 12 MILE RD",
            "address_2": "SUITE 200",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480722182",
            "telephone_number": "248-548-9090",
            "fax_number": "248-548-8462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 W 12 MILE RD",
            "address_2": "SUITE 200",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480722182",
            "telephone_number": "248-548-9090",
            "fax_number": "248-548-8462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "NEELUM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301066816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811901309",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0F37128",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4715799",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkley, MI

Sources for this page

Verify at the official NPI Registry.