Individual provider Active NPI

Mohammed Abdul Khadar Siddiqui, DO

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1508228669
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036161338 Issued in IL
Practice address
5841 S Maryland Ave
Chicago, IL 60637-1443
Phone
(888) 824-0200
NPI assigned
Mar 28, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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 036161338 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave
Chicago, IL 60637-1443

Mailing address

150 Harvester Dr Ste 300
Burr Ridge, IL 60527-5965

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220809001212 MO Practitioner - Osteopathic Manipulative MedicinePractitioner - Pediatric Medicine 8820382328 Reassigns benefits to 3 organizations
I20221201001843 IL Practitioner - Pediatric Medicine 8820382328 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince Nov 15, 2024 Accepting new patients
SSM Health Care St Louis CurrentSince Aug 1, 2022 Accepting new patients
SSM Health Care St. Louis CurrentSince Aug 1, 2022 Accepting new patients
The University of Chicago Medical Center CurrentSince Nov 15, 2024 Accepting new patients
Pcrmc Medical Group, Inc Pediatrics CurrentSince Feb 1, 2023 Accepting new patients
SSM Cardinal Glennon Childrens Hospital Pediatrics CurrentSince Aug 19, 2022 Accepting new patients
University of Chicago CurrentSince Nov 15, 2024 Accepting new patients
SSM Cardinal Glennon Children'S Hospital Pediatrics CurrentSince Aug 19, 2022 Accepting new patients
SSM Cardinal Glennon Childrens Hospital Pediatrics CurrentSince Aug 19, 2022 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

800 E 55th St
Chicago, IL 60615
Phone (773) 702-2193

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

6800 State Route 162
Maryville, IL 62062
Phone (618) 288-4095

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1465 S Grand Blvd
Rm 2712
Saint Louis, MO 63104

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

13000 Butler Crest Dr
Saint Louis, MO 63128
Phone (314) 842-3535

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Interoperability endpoints

  • Direct secure messaging: msiddiqui328247@uchospital.direct-ci.com

Organizations & group practices 9

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": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1508228669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR STE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "888-824-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "MOHAMMED",
        "middle_name": "ABDUL KHADAR",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-28",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036161338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.