NPIMap

Organization Active NPI

Hamdard Health Alliance

Doing business as Hamdard Health Addison

  • Federally Qualified Health Center (FQHC)
  • Addison, IL
National Provider Identifier
1609875053
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HAMDARD HEALTH ALLIANCE
Doing business as
Hamdard Health Addison
Practice address
228 E Lake St
Addison, IL 60101-2889
Phone
(630) 835-1430
NPI assigned
Jul 19, 2005
Last updated
Dec 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Authorized official

Name
Ms. Shawn Bailey
Title
Finance Administration Manager
Phone
(630) 835-1430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

228 E Lake St
Addison, IL 60101-2889

Mailing address

228 E Lake St
Addison, IL 60101-2889
Phone (630) 835-1430

Other identifiers 1

IdentifierTypeStateIssuer
781811OtherILPTAN

Other names 2

  • Hamdard Health Addison Doing business as
  • Hamdard Center for Health and Human Services, NFP Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040421001679 IL Part B Supplier - Clinic/Group Practice 4880680289 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Addison, IL; Chicago, IL
O20140521000002 IL Part A Provider - Federally Qualified Health Center (FQHC) 4880680289 Practice locations: Addison, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609875053. Details of each certification follow.

Federally qualified health center certification: CCN 781811

Legal name
HAMDARD HEALTH ALLIANCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2014
Last certification
Apr 2, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 15, 1992 in IL
Enrollment address
228E Lake St
Addison, IL 60101-2889

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kiran Siddiqui Individual Corporate OfficerCeo Nov 7, 2013 100%
Corporate DirectorCeo Nov 7, 2013 100%
W-2 Managing EmployeeCeo Nov 7, 2013 100%
Shawn Bailey Individual Corporate OfficerGrants & Office Admin. Nov 7, 2013 100%
Corporate DirectorGrants & Office Admin. Nov 7, 2013 100%
W-2 Managing EmployeeGrants & Office Admin. Nov 7, 2013 100%

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703548800000",
    "number": "1609875053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 E LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601012889",
            "telephone_number": "630-835-1430",
            "fax_number": "630-835-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 E LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601012889",
            "telephone_number": "630-835-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMDARD HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "FINANCE ADMINISTRATION MANAGER",
        "authorized_official_telephone_number": "630-835-1430",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "781811",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hamdard Health Addison",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hamdard Center for Health and Human Services, NFP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Hamdard Center for Health and Human Services, NFP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Addison, IL

Sources for this page

Verify at the official NPI Registry.