Shafi Siddiqi MD a Professional Corporation

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

SHAFI SIDDIQI MD A PROFESSIONAL CORPORATION

Practice address

31569 Canyon Estates Dr Ste 201
Lake Elsinore, CA 92532-0475

Phone

(951) 226-0866

Fax

(951) 226-0868

NPI assigned

Aug 17, 2021

Last updated

Aug 17, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Brigette Jackson

Title

Credentialing Specialist

Phone

(951) 667-0817

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shafi Ullah Siddiqi, M.D.

  • General Practice Physician
  • Lake Elsinore, CA
  • NPI 1538499470
  Medicare reassignment NPD
• Duane Ray Darnell, DO

  • Internal Medicine Physician
  • Sun City, CA
  • NPI 1831199728
  NPD (past)

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1477229995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31569 CANYON ESTATES DR STE 201",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320475",
            "telephone_number": "951-226-0866",
            "fax_number": "951-226-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31569 CANYON ESTATES DR STE 201",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320475",
            "telephone_number": "951-226-0866",
            "fax_number": "951-226-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAFI SIDDIQI MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRIGETTE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "951-667-0817",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "eclinicalworks",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "31569 Canyon Estates Dr Ste 201",
            "city": "Lake Elsinore",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925320475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derick Schultz
• Audrey Secord, MSW
• Serenity Home Care Facilities LLC (Aces House)
• Serenity Wellness LLC (Serenity Wellness Center)
• Nancy W Sewell, RD
• Bharti Sharma
• Ann Marie Shelton-Hinojosa, MFTI
• Damien Sheppard I
• Rex K Sheppard
• Saema Sial, PA

• General Practice Physician in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.