NPIMap

Individual provider Active NPI

Donish Siddiqi, MD

  • Family Medicine Physician
  • Holly Springs, GA
National Provider Identifier
1194168252
Registry record updated Oct 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
80152 Issued in GA
Practice address
1120 Wellstar Way Ste 204
Holly Springs, GA 30114
Phone
(470) 267-0110
Fax
(770) 999-2229
NPI assigned
Apr 9, 2013
Last updated
Oct 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 287070 NY
Family Medicine Physician 207Q00000X 80152 GA Primary

Addresses

Primary practice location

1120 Wellstar Way Ste 204
Holly Springs, GA 30114

Mailing address

1120 Wellstar Way Ste 204
Holly Springs, GA 30114-8929
Phone (470) 267-0110

Other practice location 1

120 Hobart St
Utica, NY 13501
Phone (315) 801-1149

Other identifiers 1

IdentifierTypeStateIssuer
04632711MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dsiddiqi344151@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161220001532 NY Practitioner - Family Practice 4789827965 Reassigns benefits to 1 organization
I20190916003512 GA Practitioner - Family Practice 4789827965 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians
Dima Care, IncGroup PAC ID 4385036011, 6 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

1120 Wellstar Way
Suite 305
Holly Springs, GA 30114-9086
Phone (470) 267-0135

415 Pottery Factory Dr
Commerce, GA 30529-6682
Phone (706) 336-0074

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

655 Molly LN
Woodstock, GA 30189-6519
Phone (770) 517-1080

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Aug 1, 2019 Accepting new patients
MVHS Inc CurrentSince Jan 6, 2018 Accepting new patients
Wellstar Medical Group, LLC Family Medicine Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 1, 2019 Accepting new patients
Dima Care, Inc Family Medicine CurrentSince Sep 1, 2025 Accepting new patients
MVHS Inc Family Medicine CurrentSince Jan 6, 2018 Accepting new patients

Locations

415 Pottery Factory Dr
Commerce, GA 30529
Phone (706) 336-0074

1120 Wellstar Way
Ste 204
Holly Springs, GA 30114
Phone (470) 267-0110

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

120 Hobart St
Utica, NY 13501
Phone (315) 798-1149

1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567

2209 Genesee St
Utica, NY 13501
Phone (315) 798-8100

2209 Genesee St
Ofc
Utica, NY 13501
Phone (315) 801-3282

Interoperability endpoints

  • Direct secure messaging: dsiddiqi344151@directwellstar.org

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 7

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": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1194168252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 WELLSTAR WAY STE 204",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "301148929",
            "telephone_number": "470-267-0110",
            "fax_number": "770-999-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 WELLSTAR WAY STE 204",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "470-267-0110",
            "fax_number": "770-999-2229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Hobart St",
            "address_purpose": "LOCATION",
            "city": "Utica",
            "state": "NY",
            "postal_code": "13501",
            "country_code": "US",
            "telephone_number": "315-801-1149",
            "fax_number": "315-801-3565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDIQI",
        "first_name": "DONISH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-09",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "287070",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "80152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04632711",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dsiddiqi344151@directwellstar.org",
            "affiliation": "N",
            "address_1": "1120 Wellstar Way Ste 204",
            "city": "Holly Springs",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Holly Springs, GA

Sources for this page

Verify at the official NPI Registry.