NPIMap

Individual provider Active NPI

Asif Siddiq, M.D.

  • Family Medicine Physician
  • La Verne, CA
National Provider Identifier
1467763078
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0116022902 Issued in VA
Practice address
1234 Foothill Blvd
La Verne, CA 91750-3329
Phone
(909) 596-4879
Fax
(909) 596-9199
NPI assigned
Jun 29, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0116022902 VA Primary

Addresses

Primary practice location

1234 Foothill Blvd
La Verne, CA 91750-3329

Mailing address

1234 Foothill Blvd
La Verne, CA 91750-3329
Phone (909) 596-4879

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140627001661 CA Practitioner - Family Practice 4789832072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
May Medical Management CorporationGroup PAC ID 2668757055, 5 clinicians

Practice addresses (Care Compare)

1234 Foothill Blvd
La Verne, CA 91750-3329
Phone (909) 596-4879

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
124975CAMDMarriage & Family Therapist
0116022902VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients
Afshin Saadat MD Inc Current Accepting new patients
KND Development 59 LLC Current Accepting new patients
May Medical Management Corporation Family Medicine CurrentSince Jan 1, 2017 Accepting new patients
Yong Luke Lee Medical Corporation Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
University of California Irvine Past Accepting new patients

Locations

1234 Foothill Blvd
La Verne, CA 91750
Phone (909) 596-4879

10841 White Oak Ave
Ste 107
Rch Cucamonga, CA 91730
Phone (909) 483-8361

10841 White Oak Ave
Rch Cucamonga, CA 91730
Phone (626) 914-1514

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: casacolina@direct.casacolina.org

Organizations & group practices 8

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

Hospital & facility affiliations 8

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": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1467763078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 FOOTHILL BLVD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503329",
            "telephone_number": "909-596-4879",
            "fax_number": "909-596-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 FOOTHILL BLVD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503329",
            "telephone_number": "909-596-4879",
            "fax_number": "909-596-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQ",
        "first_name": "ASIF",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116022902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Verne, CA

Sources for this page

Verify at the official NPI Registry.