NPIMap

Individual provider Active NPI

Mohammad A Siddiqui, MD

  • Internal Medicine Physician
  • Skokie, IL
National Provider Identifier
1487630513
Registry record updated Feb 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036093190 Issued in IL
Practice address
9669 N Kenton
Ste 305
Skokie, IL 60076
Phone
(847) 679-6333
Fax
(847) 679-6343
NPI assigned
Dec 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2017

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 036093190 IL Primary

Addresses

Primary practice location

9669 N Kenton
Ste 305
Skokie, IL 60076

Mailing address

9669 N Kenton
Ste 305
Skokie, IL 60076
Phone (847) 679-6333

Other identifiers 2

IdentifierTypeStateIssuer
01608395OtherILBCBS
036093190MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20100127000371 IL Practitioner - Internal Medicine 3274674874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9669 Kenton Ave
Suite 203
Skokie, IL 60076-1227
Phone (847) 679-6333

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036093190ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mohammad Siddiqui MD LTD Internal Medicine CurrentSince Apr 12, 2013 Accepting new patients
Mohammad Siddiqui Internal Medicine Past Accepting new patients
Mohammad Siddiqui, M.D.,P.a. Past Accepting new patients

Locations

9669 Kenton Ave
Ste 305
Skokie, IL 60076
Phone (847) 679-6333

9669 Kenton Ave
Ste 203
Skokie, IL 60076
Phone (847) 677-0212

9669 Kenton Ave
Ste 404
Skokie, IL 60076
Phone (847) 679-6333

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 and National Provider Directory roles.

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": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1487630513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9669 N KENTON",
            "address_2": "STE 305",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "60076",
            "telephone_number": "847-679-6333",
            "fax_number": "847-679-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9669 N KENTON",
            "address_2": "STE 305",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "60076",
            "telephone_number": "847-679-6333",
            "fax_number": "847-679-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "MOHAMMAD",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036093190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01608395",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093190",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.