Individual provider Active NPI

Amar Gupta, M.D.

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Riverside, CA
National Provider Identifier
1912340159
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianTaxonomy code 2082S0099X
License
A167029 Issued in CA
Practice address
6850 Brockton Ave Ste 108
Riverside, CA 92506-3814
Phone
(951) 313-6843
Fax
(951) 800-1850
NPI assigned
Apr 8, 2013
Last updated
Aug 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X A167029 CA Primary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X A167029 CA

Addresses

Primary practice location

6850 Brockton Ave Ste 108
Riverside, CA 92506-3814

Mailing address

6850 Brockton Ave Ste 108
Riverside, CA 92506-3814
Phone (951) 313-6843

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20210428001865 CA Practitioner - Otolaryngology 8224330204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Case Western University School of Dental Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6850 Brockton Ave
Suite 108
Riverside, CA 92506-3814
Phone (951) 313-6843

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A167029CAMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
California Face Institute Apc Plastic Surgery Within the Head and Neck CurrentSince Mar 24, 2021 Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Caritas St. Elizabeth's Medical Center Past Accepting new patients

Locations

3722 Tibbetts St
Riverside, CA 92506
Phone (951) 697-1150

6850 Brockton Ave
Ste 108
Riverside, CA 92506
Phone (951) 313-6843

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: agupta676338@nychhc.direct-ci.com

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

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1912340159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 BROCKTON AVE STE 108",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063814",
            "telephone_number": "951-313-6843",
            "fax_number": "951-800-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 BROCKTON AVE STE 108",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063814",
            "telephone_number": "951-313-6843",
            "fax_number": "951-800-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "AMAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-08",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "CA",
            "license": "A167029",
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "CA",
            "license": "A167029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.