Individual provider Active NPI

Shayan Siddiqui

  • Internal Medicine Physician
  • Rockville, MD
National Provider Identifier
1366896243
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0087870 Issued in MD
Practice address
9901 Medical Center Dr
Rockville, MD 20850-3357
Phone
(240) 826-6000
NPI assigned
Apr 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X S0987 TX
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X D0087870 MD Primary

Addresses

Primary practice location

9901 Medical Center Dr
Rockville, MD 20850-3357

Mailing address

9901 Medical Center Dr
Rockville, MD 20850-3357

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190912001816 DC Practitioner - Internal Medicine 4688967243 Reassigns benefits to 1 organization
I20200528002818 TX Practitioner - Internal Medicine 4688967243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Integrated Acute Care Services of Maryland LLCGroup PAC ID 4486900172, 178 clinicians

Practice addresses (Care Compare)

9901 Medical Ctr Dr
Rockville, MD 20850-3357
Phone (240) 826-7578

Hospital & facility affiliations

  • Adventist Healthcare Shady Grove Medical Center Hospital, Rockville, MD, CCN 210057

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0087870MDMDInternal Medicine Physician
S0987TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usacs Integrated Acute Care Services of Maryland, LLC Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Jun 1, 2020 Accepting new patients
Adventist Healthcare, Inc. Past Accepting new patients

Locations

9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000

1500 Forest Glen Rd
Silver Spring, MD 20910
Phone (301) 754-7230

5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674

11801 South Fwy
#I35W
Burleson, TX 76028
Phone (817) 293-4304

3201 W State Highway 22
Corsicana, TX 75110
Phone (903) 654-6800

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

3150 Horizon Rd
Rockwall, TX 75032
Phone (469) 697-1000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1460937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1366896243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9901 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9901 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503357",
            "telephone_number": "240-826-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "SHAYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-18",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S0987",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0087870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.