NPIMap

Individual provider Active NPI

Tahir Siddiq, M.D.

  • Specialist
  • Union Springs, AL
National Provider Identifier
1174631758
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
19681 Issued in AL
Practice address
102 Conecuh Ave W
Union Springs, AL 36089-1303
Phone
(334) 738-2140
Fax
(334) 738-1511
NPI assigned
Aug 25, 2006
Last updated
Jul 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 19681 AL Primary
Emergency Medicine Physician 207P00000X 19681 AL
Internal Medicine Physician 207R00000X 19681 AL

Addresses

Primary practice location

102 Conecuh Ave W
Union Springs, AL 36089-1303

Mailing address

102 Conecuh Ave W
Union Springs, AL 36089-1303
Phone (469) 530-4932

Other identifiers 3

IdentifierTypeStateIssuer
051034042OtherALBCBS
110128435OtherRAILROAD MEDICARE
000034042MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20111017000321 AL Practitioner - Internal MedicinePractitioner - Emergency Medicine 6800860396 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

308 Prairie St N
Union Springs, AL 36089-1417
Phone (334) 738-1499

745 Southern Springs Rd
Union Springs, AL 36089-6643
Phone (334) 738-5590

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19681ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Resources Management, Inc CurrentSince Nov 4, 1996 Accepting new patients
Tahir Siddiq CurrentSince Aug 17, 2021 Accepting new patients
Main and Associates Inc Past Accepting new patients
Crenshaw County Health Care Authority Past Accepting new patients

Locations

102 Conecuh Ave W
Union Springs, AL 36089
Phone (334) 386-0378

745 Southern Springs Rd
Union Springs, AL 36089
Phone (334) 738-5590

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southern Springs HealthcareUnion Springs, AL, CCN 015171 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2020
Oct 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Main and Associates Inc

    dba Southern Springs Healthcare Facility

    • Skilled Nursing Facility
    • Union Springs, AL
    • NPI 1609872290

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 6

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 5

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1174631758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 CONECUH AVE W",
            "city": "UNION SPRINGS",
            "state": "AL",
            "postal_code": "360891303",
            "telephone_number": "469-530-4932",
            "fax_number": "469-257-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 CONECUH AVE W",
            "city": "UNION SPRINGS",
            "state": "AL",
            "postal_code": "360891303",
            "telephone_number": "334-738-2140",
            "fax_number": "334-738-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQ",
        "first_name": "TAHIR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "19681",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "19681",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "19681",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051034042",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110128435",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000034042",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Union Springs, AL

Sources for this page

Verify at the official NPI Registry.