NPIMap

Organization Active NPI

Hamdard Health Alliance

Doing business as Hamdard Health Rogers Park

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1356772834
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HAMDARD HEALTH ALLIANCE
Doing business as
Hamdard Health Rogers Park
Practice address
1542 W Devon Ave
Chicago, IL 60660-1344
Phone
(773) 465-4600
Fax
(773) 465-4666
NPI assigned
Dec 9, 2013
Last updated
Dec 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Authorized official

Name
Ms. Shawn S Bailey
Title
Finance Administration Manager
Phone
(630) 835-1430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X IL Primary

Addresses

Primary practice location

1542 W Devon Ave
Chicago, IL 60660-1344

Mailing address

228 E Lake St
Addison, IL 60101-2889
Phone (630) 835-1430

Other names 2

  • Hamdard Health Rogers Park Doing business as
  • Hamdard Center for Health and Human Services, NFP Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040421001679 IL Part B Supplier - Clinic/Group Practice 4880680289 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Addison, IL; Chicago, IL
O20140320000371 IL Part A Provider - Federally Qualified Health Center (FQHC) 4880680289 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356772834. Details of each certification follow.

Federally qualified health center certification: CCN 781812

Legal name
HAMDARD HEALTH ALLIANCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 14, 2014
Last certification
Apr 14, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 15, 1992 in IL
Enrollment address
1542W Devon Ave
Chicago, IL 60660-1344

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2077663Hamdard Ctr for Health and Human SVCS1542 W Devon Ave, Chicago, IL 60660Certificate of waiverMay 12, 2028

National Provider Directory

National Provider Directory

Locations

228 E Lake St
Addison, IL 60101
Phone (630) 835-1430

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kiran Siddiqui Individual Corporate OfficerCoo Nov 7, 2013 100%
W-2 Managing EmployeeCoo Nov 7, 2013 100%
Shawn Bailey Individual Corporate OfficerGrants & Office Adm Nov 7, 2013 100%
Corporate DirectorGrants & Office Adm Nov 7, 2013 100%
W-2 Managing EmployeeGrants & Office Adm Nov 7, 2013 100%
Adnaan Hamid Individual Corporate OfficerCfo Nov 7, 2013 100%
W-2 Managing EmployeeCfo Nov 7, 2013 100%
Mohammad Hamid Individual Corporate OfficerCeo/PH.D. Nov 7, 2013 100%
Corporate DirectorCeo/PH.D. Nov 7, 2013 100%
W-2 Managing EmployeeCeo/PH.D. Nov 7, 2013 100%

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703548800000",
    "number": "1356772834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 E LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601012889",
            "telephone_number": "630-835-1430",
            "fax_number": "630-835-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601344",
            "telephone_number": "773-465-4600",
            "fax_number": "773-465-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMDARD HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "FINANCE ADMINISTRATION MANAGER",
        "authorized_official_telephone_number": "630-835-1430",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hamdard Health Rogers Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hamdard Center for Health and Human Services, NFP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Hamdard Center for Health and Human Services, NFP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.