NPIMap

Organization Active NPI

Siebert Moazzam P C

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Peoria, IL
National Provider Identifier
1396780292
Registry record updated Apr 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
036101798 Issued in IL
Legal business name
SIEBERT MOAZZAM P C
Practice address
401 Main Street
Suite 1200
Peoria, IL 61602-1242
Phone
(309) 671-8749
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2011

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

Authorized official

Name
Paul A Siebert, MDNPI 1154337236
Title
Owner
Phone
(309) 353-1833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X 036101798 IL Primary

Addresses

Primary practice location

401 Main Street
Suite 1200
Peoria, IL 61602-1242

Mailing address

2205 State St
Pekin, IL 61554-3936
Phone (309) 353-1833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090515000361 IL Part B Supplier - Clinic/Group Practice 2567511876 Receives reassigned benefits from 2 practitioners
Practice locations: Pekin, IL

National Provider Directory

National Provider Directory

Locations

2205 State St
Pekin, IL 61554
Phone (309) 353-1833

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302566400000",
    "number": "1396780292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 STATE ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615543936",
            "telephone_number": "309-353-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MAIN STREET",
            "address_2": "SUITE 1200",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021242",
            "telephone_number": "309-671-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIEBERT MOAZZAM P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2011-04-12",
        "status": "A",
        "authorized_official_last_name": "SIEBERT",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-353-1833",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036101798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.