NPIMap

Individual provider Active NPI

Mohammad T Siddiqui, M.D.

  • Nephrology Physician
  • Kissimmee, FL
National Provider Identifier
1003858275
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME98002 Issued in FL
Practice address
1101 N Central Ave
Kissimmee, FL 34741-4405
Phone
(407) 851-5600
Fax
(407) 438-0507
NPI assigned
Jun 12, 2006
Last updated
Sep 28, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 17468 MS
Nephrology Physician 207RN0300X ME98002 FL Primary

Addresses

Primary practice location

1101 N Central Ave
Kissimmee, FL 34741-4405

Mailing address

3885 Oakwater Cir
Orlando, FL 32806-6257
Phone (407) 851-5600

Other identifiers 3

IdentifierTypeStateIssuer
7280103OtherFLAETNA
94661OtherFLBC/BS
2191106OtherFLUNITED HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070619000636 FL Practitioner - NephrologyPractitioner - Internal Medicine 4587656848 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Florida Kidney Specialists IncGroup PAC ID 6608233705, 38 clinicians

Practice addresses (Care Compare)

1121 N Central Ave
Kissimmee, FL 34741-4405
Phone (407) 933-2210

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17468MSMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Central Florida, P.a. Nephrology CurrentSince Jun 1, 2010 Accepting new patients
Central Florida Kidney Specialists Inc Nephrology CurrentSince Jun 1, 2023 Accepting new patients
Clarksdale Hma Physican Management, LLC Past Accepting new patients
Nephrology Associates of the Carolinas, P.a. Nephrology PastSince Jun 1, 1997 Accepting new patients
Clarksdale Hma Physician Management LLC Nephrology Past Accepting new patients
Kissimmee Nephrology & Hypertension, PA Nephrology Past Accepting new patients
Kissimmee Nephrology & Hypertension, PA Nephrology Past Accepting new patients

Locations

1101 N Central Ave
Kissimmee, FL 34741
Phone (407) 284-1993

1121 N Central Ave
Kissimmee, FL 34741
Phone (407) 933-1221

1121 N Central Ave
Ste B
Kissimmee, FL 34741
Phone (407) 933-1221

1511 Sligh Blvd
Unit A
Orlando, FL 32806
Phone (407) 317-9000

2501 N Orange Ave
Ste 537N
Orlando, FL 32804
Phone (407) 894-4693

3885 Oakwater Cir
Orlando, FL 32806
Phone (407) 816-5700

4555 Pleasant Hill Rd
Poinciana, FL 34759
Phone (407) 348-1780

Networks

  • FL HMO
  • FL HMO D-SNP
  • FL PPO
  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network
  • FL HMO C-SNP

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JCJCBA
  • Direct secure messaging: mohammad.siddiqui@direct.davitaphysiciansolutions.com

Organizations & group practices 7

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254096000000",
    "number": "1003858275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3885 OAKWATER CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328066257",
            "telephone_number": "407-851-5600",
            "fax_number": "407-438-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N CENTRAL AVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414405",
            "telephone_number": "407-851-5600",
            "fax_number": "407-438-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "MOHAMMAD",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2009-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MS",
            "license": "17468",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME98002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7280103",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "94661",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2191106",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.