NPIMap

Individual provider Active NPI

Pavan Kumar Gupta, MD

  • Cardiovascular Disease Physician
  • O'Fallon, IL
National Provider Identifier
1861519563
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036130576 Issued in IL
Practice address
Three Saint Elizabeth Blvd Ste 2800
O Fallon, IL 62269-1282
Phone
(618) 233-6044
Fax
(833) 973-4218
NPI assigned
Mar 26, 2007
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301083827 MI
Internal Medicine Physician 207R00000X MD13290 RI
Internal Medicine Physician 207R00000X 4301083827 MI
Cardiovascular Disease Physician 207RC0000X 036130576 IL Primary
Hospitalist Physician 208M00000X 4301083827 MI

Addresses

Primary practice location

Three Saint Elizabeth Blvd Ste 2800
O Fallon, IL 62269-1282

Mailing address

Three Saint Elizabeth Blvd Ste 2800
O Fallon, IL 62269-1282
Phone (618) 233-6044

Other identifiers 1

IdentifierTypeStateIssuer
036130576MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pgupta97539@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20121009000432 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 2264525526 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Pittsburgh School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Holy Family Hospital IncGroup PAC ID 7517879349, 25 clinicians

Practice addresses (Care Compare)

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

12866 Troxler Ave
Highland, IL 62249-2806
Phone (618) 651-2600

200 Health Care Dr
Greenville, IL 62246-1154
Phone (618) 664-1230

3 Saint Elizabeth Blvd
Suite 2800
O Fallon, IL 62269-1099
Phone (618) 233-6044

9515 Holy Cross LN
Breese, IL 62230-3618
Phone (618) 526-4511

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD13290RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order Current Accepting new patients
HSHS Holy Family Hospital Inc CurrentSince Jun 1, 2020 Accepting new patients
St Josephs Hospital of the Hospital Sisters of the Third Order of St F CurrentSince Aug 11, 2018 Accepting new patients
St Josephs Hospital Breese of the Hospital Sisters of the Third Orde CurrentSince Aug 26, 2018 Accepting new patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order CurrentSince Apr 1, 2015 Accepting new patients
St Josephs Hospital Breese of the Hospital Sisters of the Third Orde CurrentSince Aug 26, 2018 Accepting new patients

Locations

200 Health Care Dr
Greenville, IL 62246
Phone (618) 664-0808

200 Health Care Dr
#1501
Greenville, IL 62246
Phone (616) 664-1230

12866 Troxler Ave
Highland, IL 62249
Phone (618) 651-2600

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

9515 Holy Cross Ln
Saint Rose, IL 62230
Phone (618) 526-4511

3051 Hollis Dr
Springfield, IL 62704
Phone (217) 523-5406

Interoperability endpoints

  • Direct secure messaging: pgupta97539@ewd.direct.hshs.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
HSHS Medical Group IncHighland, IL, CCN 783813 Rural health clinic Corporate Director Mar 15, 2025
HSHS Medical Group Family Medicine - AltamontAltamont, IL, CCN 783851 Rural health clinic Corporate Officer Feb 23, 2026

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1861519563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "THREE SAINT ELIZABETH BLVD STE 2800",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691282",
            "telephone_number": "618-233-6044",
            "fax_number": "833-973-4218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THREE SAINT ELIZABETH BLVD STE 2800",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691282",
            "telephone_number": "618-233-6044",
            "fax_number": "833-973-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "PAVAN",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301083827",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD13290",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301083827",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036130576",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "4301083827",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036130576",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgupta97539@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "Three Saint Elizabeth Blvd Ste 2800",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622691282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.