Mohamad Zia Siddiqui, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

S2509 Issued in TX

Practice address

6451 Brentwood Stair Rd Ste 200
Fort Worth, TX 76112-3200

Phone

(972) 249-0206

NPI assigned

Aug 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Family Practice

Education

Lake Erie College of Osteopathic Medicine, Erie, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Experts of Texas, P.a.Group PAC ID 0143224170, 3 clinicians

CS Pacs 3 Southwest, LLCGroup PAC ID 1254879620, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valor Hospice Hospice, Fort Worth, TX, CCN 741787
• The Heart Hospital Baylor Denton Hospital, Denton, TX, CCN 450893
• Grapevine Medical Lodge Nursing home, Grapevine, TX, CCN 676104
• Westpark Rehabilitation and Living Nursing home, Euless, TX, CCN 676029
• The Villages on MacArthur Nursing home, Irving, TX, CCN 676358

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10780/brand/1/csg/1/fhir/r4
• Direct secure messaging: msiddiqui1093107@direct.sw.org

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Decatur Hospital Authority

  dba Grapevine Medical Lodge

  • Skilled Nursing Facility
  • Grapevine, TX
  • NPI 1336543081

  Adp of the SNF

  CMS ownership

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.

• CS Pacs 3 Southwest, LLC

  • Hospitalist Physician
  • Baytown, TX
  • NPI 1275398430
  Medicare reassignment Care Compare group NPD
• Medical Experts of Texas, P.a.

  • Hospitalist Physician
  • Lewisville, TX
  • NPI 1730395989
  Medicare reassignment Care Compare group NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936
  Medicare reassignment NPD
• Ipc Pac Healthcare Services of Texas PLLC

  • Hospitalist Physician
  • Addison, TX
  • NPI 1194174201

  Family Medicine

  Medicare reassignment NPD
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809

  TX

  Medicare reassignment NPD
• Healthtexas Provider Network

  dba Symmetry Anesthesia

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Colleyville, TX
  • NPI 1235135906
  NPD
• Decatur Hospital Authority

  dba Grapevine Medical Lodge

  • Skilled Nursing Facility
  • Grapevine, TX
  • NPI 1336543081
  NPD (past)
• Eastland Memorial Hospital District

  dba Westpark Rehabilitation and Living

  • Skilled Nursing Facility
  • Euless, TX
  • NPI 1851752729
  NPD (past)
• Hamilton County Hospital District

  dba The Eden of Las Colinas

  • Skilled Nursing Facility
  • Irving, TX
  • NPI 1982698742
  NPD (past)
• South Limestone Hospital District

  dba The Villages on MacArthur

  • Skilled Nursing Facility
  • Irving, TX
  • NPI 1699114785
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Decatur Hospital Authority

  dba Grapevine Medical Lodge

  • Skilled Nursing Facility
  • Grapevine, TX
  • NPI 1336543081

  Nursing home

  Care Compare affiliation
• Eastland Memorial Hospital District

  dba Westpark Rehabilitation and Living

  • Skilled Nursing Facility
  • Euless, TX
  • NPI 1851752729

  Nursing home

  Care Compare affiliation
• Epic Hospice Care LLC

  dba Valor Hospice

  • Community Based Hospice Care Agency
  • Fort Worth, TX
  • NPI 1972039949
  Care Compare affiliation
• South Limestone Hospital District

  dba The Villages on MacArthur

  • Skilled Nursing Facility
  • Irving, TX
  • NPI 1699114785

  Nursing home

  Care Compare affiliation
• Thhbp Management Company LLC

  dba Baylor Scott & White the Heart Hospital - Denton

  • General Acute Care Hospital
  • Denton, TX
  • NPI 1194753590
  Care Compare affiliation

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

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1568742666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5870 N HIATUS RD",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333216424",
            "telephone_number": "888-447-2362",
            "fax_number": "865-560-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6451 BRENTWOOD STAIR RD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123200",
            "telephone_number": "972-249-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "MOHAMAD",
        "middle_name": "ZIA",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-19",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "278779",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "278779-1",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "S2509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04349060",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Sickles, OTR
• Zara N. Siddiq, DO
• Muhammad Naveed Siddiqi, MD
• Muhammad Talal Siddique, M.D.
• Mehdi Siddiqui, MD
• Salma Z Siddiqui, DDS
• Richard Alan Sidebottom, M.D.
• Kathleen Sides
• Misty Leann Sides, CPNP-AC
• Seraphima Sidhom, MD, MSC

• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.