Shanta Gautham, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11672 Issued in ND

Practice address

725 Hamline St - Altru Family Medicine Residency
Grand Forks, ND 58203

Phone

(701) 780-6800

Fax

(781) 744-5358

NPI assigned

Mar 13, 2008

Last updated

Mar 5, 2019By the provider in NPPES

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 names 1

• Shanta Subramanian Former name

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

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 2

Specialty

Internal Medicine

Education

University of Missouri, Columbia School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Altru Health SystemGroup PAC ID 1355251604, shared by 14 NPIs, 675 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Altru's Home Health Home health agency, Grand Forks, ND, CCN 357014
• Good Samaritan Society Home Care Home health agency, Devils Lake, ND, CCN 357007
• Altru Hospital Hospital, Grand Forks, ND, CCN 350019

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Altru Health System

  dba Altru 1300 Columbia

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  Internal Medicine

  Medicare reassignment NPD
• Altru Health System

  dba Altru Clinic Crookston

  • Clinic/Center
  • Crookston, MN
  • NPI 1760494330
  Medicare reassignment NPD
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  NPD
• Altru Health System

  dba Altru Clinic - Thief River Falls

  • Rural Health Clinic/Center
  • Thief River Falls, MN
  • NPI 1285074328
  NPD

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

• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  Care Compare affiliation
• Altru Health System

  dba Altru Home Health

  • Home Health Agency
  • Grand Forks, ND
  • NPI 1346339850
  Care Compare affiliation
• The Evangelical Lutheran Good Samaritan Society

  dba Good Samaritan Society - Home Care

  • Home Health Agency
  • Devils Lake, ND
  • NPI 1841272226
  Care Compare affiliation

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551744000000",
    "number": "1851562375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891",
            "fax_number": "781-744-5358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 HAMLINE ST - ALTRU FAMILY MEDICINE RESIDENCY",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58203",
            "telephone_number": "701-780-6800",
            "fax_number": "781-744-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTHAM",
        "first_name": "SHANTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-13",
        "last_updated": "2019-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "11672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANTA",
            "last_name": "SUBRAMANIAN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Briana Garvey
• Andrew V Gasparini, MD
• Geoffrey Gaukler, LCPC, LPCC
• Gerald R. Gaul, M.D.
• Joanne N Gaul, MD
• Nyah-Ziawon (Will) Gaypia
• Shyann Irene Gbieor
• Kristen Gee
• Randolph Gee
• Paul Thomas German, MD

• Internal Medicine Physician in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Internal Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.
• 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.