NPIMap

Individual provider Active NPI

Farjaad Siddiq, M.D.

  • Urology Physician
  • Lake Charles, LA
National Provider Identifier
1346231065
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
15753R Issued in LA
Practice address
1715 Wolf Cir
Lake Charles, LA 70605-2353
Phone
(337) 480-7499
Fax
(337) 480-7498
NPI assigned
Nov 2, 2005
Last updated
Jun 9, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 15753R LA Primary

Addresses

Primary practice location

1715 Wolf Cir
Lake Charles, LA 70605-2353

Mailing address

PO Box 122525 Dept 2525
Dallas, TX 75312-0001
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
1478199MedicaidLA
P00196869OtherLARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20050302000048 LA Practitioner - Urology 3476506403 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Warren Alpert Medical School of Brown University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Charles Medical Services Urology LLCGroup PAC ID 4284738063, 5 clinicians

Practice addresses (Care Compare)

1715 Wolf Cir
Lake Charles, LA 70605-2353
Phone (337) 480-7499

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15753RLAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Feb 21, 2019 Accepting new patients
Ochsner Clinic LLC CurrentSince Feb 21, 2019 Accepting new patients
Ochsner Clinic LLC Current Accepting new patients
Lake Charles Medical Services Urology LLC Urology CurrentSince Oct 14, 2019 Accepting new patients

Locations

1715 Wolf Cir
Lake Charles, LA 70605
Phone (337) 480-7499

2770 3rd Ave
Ste 240
Lake Charles, LA 70601
Phone (337) 494-4656

4150 Nelson Rd
Ste G
Lake Charles, LA 70605
Phone (337) 310-0440

4200 Nelson Rd
Lake Charles, LA 70605
Phone (318) 474-6370

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

619 S Huntington St
Sulphur, LA 70663
Phone (337) 494-3278

Interoperability endpoints

  • Direct secure messaging: fsiddiq5281921@direct.casso.us.com

Organizations & group practices 4

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 11

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1346231065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122525 DEPT 2525",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 WOLF CIR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706052353",
            "telephone_number": "337-480-7499",
            "fax_number": "337-480-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQ",
        "first_name": "FARJAAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "LA",
            "license": "15753R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1478199",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00196869",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.