Individual provider Active NPI

Hateem Siddiqui

  • Internal Medicine Physician
  • San Bernardino, CA
National Provider Identifier
1487099669
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A139511 Issued in CA
Practice address
1800 Western Ave Ste 409
San Bernardino, CA 92411-1355
Phone
(909) 202-4336
Fax
(909) 222-6023
NPI assigned
May 1, 2013
Last updated
Jun 19, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A139511 CA Primary

Addresses

Primary practice location

1800 Western Ave Ste 409
San Bernardino, CA 92411-1355

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

Other practice location 1

13677 Foothill Blvd Ste Q
Fontana, CA 92335-0214
Phone (909) 202-4336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20170509002902 CA Practitioner - Internal Medicine 7618254137 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1800 Western Ave
Suite 409
San Bernardino, CA 92411-1355
Phone (909) 202-4336

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A139511CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hateem Siddiqui MD PC Internal Medicine CurrentSince Apr 1, 2025 Accepting new patients
Foothill Family Medical Clinic Inc PastSince Jan 8, 2015 Accepting new patients
Caremore Health Plan PastSince Jan 27, 2020 Accepting new patients

Locations

13677 Foothill Blvd
Ste Q
Fontana, CA 92335
Phone (909) 202-4336

1800 Western Ave
Ste 302
Sn Bernrdno, CA 92411
Phone (909) 713-2323

1800 Western Ave
Ste 409
Sn Bernrdno, CA 92411
Phone (909) 202-4336

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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 4

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": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1487099669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 WESTERN AVE STE 409",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111355",
            "telephone_number": "909-202-4336",
            "fax_number": "909-222-6023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13677 Foothill Blvd Ste Q",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923350214",
            "country_code": "US",
            "telephone_number": "909-202-4336",
            "fax_number": "909-222-6023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "HATEEM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-01",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A139511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.