Individual provider Active NPI

Sabeeha Haque Ali, MD

  • Pediatrics Physician
  • Danville, IL
National Provider Identifier
1417033705
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036109029 Issued in IL
Practice address
102 N Logan Ave
Danville, IL 61832-8513
Phone
(217) 442-5863
Fax
(217) 442-5040
NPI assigned
Oct 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036109029 IL Primary

Addresses

Primary practice location

102 N Logan Ave
Danville, IL 61832-8513

Mailing address

102 N Logan Ave
Danville, IL 61832-8513
Phone (217) 442-5863

Other identifiers 1

IdentifierTypeStateIssuer
463483975001MedicaidIL

Other names 1

  • Dr. Sabeeha Haque Professional name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190528000247 IL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 0345259800

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036109029ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sabeeha Haque Ali MD LLC CurrentSince Dec 10, 2013 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

102 N Logan Ave
Danville, IL 61832
Phone (217) 442-5863

Interoperability endpoints

  • Direct secure messaging: sabeeha.haque.1@8935.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Riverview PediatricsDanville, IL, CCN 148931 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control
Nov 1, 2013
Nov 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1162080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1417033705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618328513",
            "telephone_number": "217-442-5863",
            "fax_number": "217-442-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618328513",
            "telephone_number": "217-442-5863",
            "fax_number": "217-442-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAQUE ALI",
        "first_name": "SABEEHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-29",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036109029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463483975001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SABEEHA",
            "last_name": "HAQUE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Danville, IL

Sources for this page

Verify at the official NPI Registry.