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DR. AJAY K GUPTA M.D.
NPI 1316049265
Ophthalmology in Sheboygan, WI

Active since September 02, 2006PECOS EnrolledAccepts Medicare Assignment
64.25/100
CMS Quality Rating
3113 SAEMANN AVE, SHEBOYGAN, WI 53081(920) 496-4700 Get Directions Write a Review

NPPES record last updated: April 22, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 22, 2024, Feb 9, 2024, Dec 24, 2019 (3 updates tracked since 2019).

About Dr. Ajay K Gupta M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. AJAY K GUPTA M.D. (NPI 1316049265) is an individual ophthalmology provider in Sheboygan, Wisconsin, licensed in Wisconsin (71682-20) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Javon Bea Hospital, and is a graduate of University Of Cincinnati College Of Medicine (1999).

NPPES Registry Identity

NPI1316049265
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameDR. AJAY K GUPTACredential: M.D.
Location Address3113 SAEMANN AVESheboygan, WI 53081-1957
Mailing Address3113 Saemann AveSheboygan, WI 53081-1957 · (920) 496-4700
Phone(920) 496-4700
Sole ProprietorYes
Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 1999
Enumeration DateSeptember 2, 2006
Last NPPES UpdateApril 22, 20243 updates tracked since enumeration
NPPES CertifiedApril 22, 2024
✔ NPI 1316049265 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
Licenses✔ Licensed in WI · 71682-20✔ Licensed in OH · OH 35 084276
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
3113 SAEMANN AVE, Sheboygan, WI 53081
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Other Identifiers 3

Medicaid2551662OH
Medicaid100095643WI
Other000000358460OH · Anthem Bcbs

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include MercyCare Health Plans, Quartz.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Ajay K Gupta M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254382088
PECOS Enrollment IDI20220609002699
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
29 services26 patients
Measurement of corneal curvature and depth of eye 92136
This procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.
26 services17 patients
Removal of cataract with insertion of prosthetic lens 66984
This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
23 services14 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
18 services14 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
14 services14 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
12 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Javon Bea Hospital

Acute Care Hospitals · Rockford, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140239
Location8201 E Riverside BlvdRockford, IL 61114 · Winnebago County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53081 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$123.69 typical visit price
range $53.90 – $163.24
Typical copayment $30.92 (range $13.47 – $40.81)
Most-billed visit code 99204
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

64.25/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality100
Promoting Interoperability0
Improvement Activities40
Cost64.18

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. RACHEL EMILY REJNIAK AGPCNP-BC
Nurse Practitioner (Gerontology)
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
DR. ABDELOUAHID SOUALA MD
Surgery
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
DR. THOMAS JOHN ZWEIFEL D.O.
Psychiatry & Neurology (Neurology)
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
ST. NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS
Internal Medicine
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
ABBY VERCIO M.D.
Ophthalmology
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
ST. NICHOLAS HOSPITAL - SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Durable Medical Equipment & Medical Supplies
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
KELSEY R LAUTERBACH PA-C
Physician Assistant
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700
DR. EMILY J FISHER AU.D.
Audiologist
3113 SAEMANN AVE
SHEBOYGAN, WI 53081
Sheboygan County (920) 496-4700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ajay Gupta's NPI number?

The NPI number for Ajay Gupta is 1316049265. It was assigned to this individual provider in the NPPES registry on September 2, 2006.

Where is Ajay Gupta located?

Ajay Gupta practices at 3113 Saemann Ave, Sheboygan, WI 53081. The listed phone number is (920) 496-4700.

What is Ajay Gupta's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Ajay Gupta enrolled in Medicare?

Yes. Ajay Gupta is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Ajay Gupta accept?

Health plans from MercyCare Health Plans and Quartz list Ajay Gupta as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Ajay Gupta affiliated with any hospitals?

According to CMS data, Ajay Gupta is affiliated with Javon Bea Hospital.

When was this NPI record last updated?

The NPPES record for Ajay Gupta was last updated on April 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.