Hira Tariq, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.157745 Issued in IL

Practice address

1200 W State St
Rockford, IL 61102-2112

Phone

(815) 490-1600

Fax

(815) 490-1881

NPI assigned

Jun 25, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Crusaders Central Clinic Association

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1902972557
  NPD (past)

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1407341118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1400",
            "fax_number": "815-490-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARIQ",
        "first_name": "HIRA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2021-08-04",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036157745",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125073304",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "12507304",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.157745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchell Glenn Eustaquio Tan, DNP, APRN,PMHNP-BC
• Brenda Marie Tanker
• Ty Alexander Tanker, AU.D.
• Eric Jon Tanner, LCPC
• George Chahine Tannous, M.D.
• Saad Tariq, MD
• Florentina Tase, APN
• Shiraz P Tata, PH.D.
• Dominique Tatum
• Jane Taylor Greenfield, D.MIN LCPC

• Family Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.