NPIMap

Organization Active NPI

Jefferson Street Family Practice

  • Family Medicine Physician
  • Austin, TX
National Provider Identifier
1871690040
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JEFFERSON STREET FAMILY PRACTICE
Practice address
1101 W 40TH St
Austin, TX 78756-3609
Phone
(512) 459-4147
Fax
(512) 459-9134
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ajay Kumar Gupta, M.D.
Title
President
Phone
(512) 458-3185

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1101 W 40TH St
Austin, TX 78756-3609

Mailing address

1101 W 40TH St
Austin, TX 78756-3609
Phone (512) 459-4147

National Provider Directory

National Provider Directory

Locations

1101 W 40th St
Austin, TX 78756
Phone (512) 459-4147

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871690040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 W 40TH ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563609",
            "telephone_number": "512-459-4147",
            "fax_number": "512-459-9134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W 40TH ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563609",
            "telephone_number": "512-459-4147",
            "fax_number": "512-459-9134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON STREET FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "AJAY",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-458-3185",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.