Individual provider Active NPI

Amena Iqbal

  • Endocrinology, Diabetes & Metabolism Physician
  • Saint Joseph, MI
National Provider Identifier
1124469523
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
4301115218 Issued in MI
Practice address
3950 Hollywood Rd
Saint Joseph, MI 49085-9159
Phone
(269) 408-1600
Fax
(269) 408-1602
NPI assigned
Jul 13, 2013
Last updated
Sep 13, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.065211 IL
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 4301115218 MI Primary

Addresses

Primary practice location

3950 Hollywood Rd
Saint Joseph, MI 49085-9159

Mailing address

2704 W Arthur Ave
Apt 3S
Chicago, IL 60645-5235
Phone (312) 912-3927

Other practice location 1

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 983-5334

Other practice location 2

4646 N Marine Dr
Suite 7100
Chicago, IL 60640-5759
Phone (773) 564-5225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20180820002466 MI Practitioner - Endocrinology 3476776220 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

3950 Hollywood Rd
Saint Joseph, MI 49085-9151

3950 Hollywood Rd
Suite 288
Saint Joseph, MI 49085-9159
Phone (269) 408-1600

9623 Red Arrow Hwy
Bridgman, MI 49106-9559
Phone (269) 465-6050

9625 Red Arrow Hwy
Bridgman, MI 49106-9559
Phone (269) 465-6050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.065211ILMDInternal Medicine Physician
4301115218MIMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Assoc of Southwestern Michigan, PC Current Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince May 12, 2019 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince May 12, 2019 Accepting new patients
Lakeland Medical Practices Internal Medicine CurrentSince Aug 7, 2018 Accepting new patients
Lakeland Medical Practices Internal Medicine CurrentSince Aug 7, 2018 Accepting new patients

Locations

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Saint Joseph, MI 49085
Phone (269) 408-0990

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

3950 Hollywood Rd
Ste 288
Saint Joseph, MI 49085
Phone (269) 408-0990

Interoperability endpoints

  • Direct secure messaging: aiqbal1270057@epic00.corewelldirect.org
  • Direct secure messaging: aiqbal32964@lakeland.midirect.net

Organizations & group practices 5

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 2

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": "1373673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1124469523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 W ARTHUR AVE",
            "address_2": "APT 3S",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606455235",
            "telephone_number": "312-912-3927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 HOLLYWOOD RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859159",
            "telephone_number": "269-408-1600",
            "fax_number": "269-408-1602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1234 Napier Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MI",
            "postal_code": "490852112",
            "country_code": "US",
            "telephone_number": "269-983-5334",
            "fax_number": "269-408-1602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4646 N Marine Dr",
            "address_2": "Suite 7100",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606405759",
            "country_code": "US",
            "telephone_number": "773-564-5225",
            "fax_number": "773-564-5226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IQBAL",
        "first_name": "AMENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-13",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.065211",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "4301115218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

Verify at the official NPI Registry.