GAUTAM GANGULY – General Practice Physician, NPI 1669849824
General Practice Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for GAUTAM GANGULY
683 SUMMIT AVE
APT 1
JERSEY CITY, NJ 073062536
Phone: (201) 294-0073
Type: Mailing
2308 AVE BORINQUEN APT 19
SANTURCE
SAN JUAN, PR 009154427
Phone: (201) 294-0073
Type: Location
3775 N Lecanto Hwy
Beverly Hills, FL 344653559
Phone: (352) 746-0600
Type: Location
1542 Kingsley Ave Ste 146
Orange Park, FL 320734547
Phone: (904) 269-2990
Type: Location
PO BOX 640573
STE 146
BEVERLY HILLS, FL 344640573
Phone: (352) 746-0600
Fax: (352) 746-0607
Type: Mailing
3775 N LECANTO HWY
BEVERLY HILLS, FL 344653559
Phone: (352) 746-0600
Fax: (352) 746-0607
Type: Location
1542 KINGSLEY AVE
STE 146
ORANGE PARK, FL 320734547
Phone: (201) 294-0073
Type: Mailing
1542 KINGSLEY AVE STE 146
ORANGE PARK, FL 320734547
Phone: (904) 269-2990
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $192.
Total Amount is formed as General ($192) + Research ($0) + Ownership ($0) = $192.
Last reported payment date: 2024-10-23 • Largest payer in this snapshot: Alexion Pharmaceuticals, Inc. ($192).
Total Amount
$192
General + Research + Ownership
Payments
7
Total payment records
General Amount
$192
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Alexion Pharmaceuticals, Inc. | $192 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-07-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170419002304 | I | General Practice | PR | TBD |
| I20220721001788 | I | General Practice | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 57 | 39 | $0 |
Insurance plans in this area (ZIP 07306)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | FL | |
| Family Practice | FL | |
| Internal Medicine | FL | |
| Family Practice | FL | |
| Internal Medicine | FL | |
| - | FL | |
| Family Practice | FL | |
| Internal Medicine | FL | |
| Physician Assistant | FL | |
| Internal Medicine, Cardiovascular Disease (Cardiology) | FL |
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