Active NPI
Neena R Gupta, MD
- Pediatric Nephrology Physician
- Worcester, MA
National Provider Identifier
1972615052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nephrology Physician
- License
- 242003
- Practice address
- 55 Lake Ave N
Department of Pediatrics
Worcester, MA 01655-0002 - Phone
- (774) 442-5695
- Fax
- (774) 443-7399
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD11111 | RI | |
| Pediatric Nephrology Physician | 2080P0210X | MD11111 | RI | |
| Pediatric Nephrology Physician | 2080P0210X | 242003 | MA | Primary |
Addresses
Primary practice location
55 Lake Ave N
Department of Pediatrics
Worcester, MA 01655-0002
Mailing address
PO Box 415348
Boston, MA 02241-0001
Phone (800) 225-8885
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N655193 | Medicaid | RI | |
| 00137071 | Other | MA | MEDICARE |
| 110083785A | Medicaid | MA | |
| 241728 | Other | RI | BLUE CROSS |
| 28463 | Other | RI | NEIGHBORHOOD HEALTH PLAN |
| 001370701 | Other | MA | MEDICARE |
| 1203613 | Other | RI | UNITED HEALTH |
| 410398 | Other | RI | BLUE CHIP |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ngupta22814@UmassMemorial.direct-ci.com | ||
| FHIR URL | https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD11111 | RI | MD | Pediatrics Physician |
| 242003 | MA | MD | Pediatric Nephrology Physician |
Interoperability endpoints
- ngupta22814@umassmemorial.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1972615052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 415348",
"city": "BOSTON",
"state": "MA",
"postal_code": "022410001",
"telephone_number": "800-225-8885",
"fax_number": "508-334-1977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVE N",
"address_2": "DEPARTMENT OF PEDIATRICS",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016550002",
"telephone_number": "774-442-5695",
"fax_number": "774-443-7399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "NEENA",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "RI",
"license": "MD11111",
"primary": false
},
{
"code": "2080P0210X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Nephrology",
"state": "RI",
"license": "MD11111",
"primary": false
},
{
"code": "2080P0210X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Nephrology",
"state": "MA",
"license": "242003",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N655193",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "00137071",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110083785A",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "241728",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "28463",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "001370701",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH",
"identifier": "1203613",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "410398",
"state": "RI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ngupta22814@UmassMemorial.direct-ci.com",
"affiliation": "N",
"address_1": "55 Lake Ave N",
"address_2": "Department of Pediatrics",
"city": "Worcester",
"state": "MA",
"country_code": "US",
"postal_code": "016550002",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "55 Lake Ave N",
"address_2": "Department of Pediatrics",
"city": "Worcester",
"state": "MA",
"country_code": "US",
"postal_code": "016550002",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.