Omer Asif Siddiqui, M.D.
Individual provider Active NPI Nephrology Physician · Memphis, TN
NPI 1659577278 · NPPES record last updated Jul 9, 2025
Key facts
- NPI
- 1659577278
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 46512 (TN)
- Practice address
- 1325 Eastmoreland Ave Ste 445
Memphis, TN 38104-7536 - Phone
- (901) 866-8810
- Fax
- (901) 302-2450
- NPI assigned
- Jun 21, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ut Medical Group Inc
Greenbrook Physician Services, LLC
Practice addresses (Care Compare)
1325 Eastmoreland
Suite 545
Memphis, TN 38104-7510
Phone (901) 866-8220
4250 Bethel Rd
Olive Branch, MS 38654-8737
Phone (901) 866-8360
7318 Southcrest Pkwy
Southaven, MS 38671-4773
Phone (901) 866-8810
7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (662) 772-4000
Hospital & facility affiliations
- RCG Southaven
- DaVita Pace Road Dialysis
- Baptist Memorial Hospital
- St Francis Hospital
- Methodist Healthcare - Olive Branch Hospital
- Baptist Memorial Hospital Desoto
- Methodist Hospitals of Memphis
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.15 of 100
- Quality
- 59.97
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 80.93
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110616000804 | TN | Practitioner - Nephrology |
6305030768 | Reassigns benefits to 3 organizations |
| I20151207000905 | MS | Practitioner - Nephrology |
6305030768 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E6551 | AR | MD | Internal Medicine Physician |
| 23721 | MS | MD | Internal Medicine Physician |
| 46512 | TN | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Physician Services PC | Internal Medicine | Current |
Accepting new patients |
| Hospital Care Consultants of Paragould LLC | Internal Medicine | Past | Accepting new patients |
Locations
2305 Chambliss Ave NW
Cleveland, TN 37311
Phone (423) 559-6000
6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190
1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061
Interoperability endpoints
- osiddiqui14528@direct.bmhcc.org
- osiddiqui45566@mlh.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 23721 | MS | |
| Internal Medicine Physician | 207R00000X | E6551 | AR | |
| Internal Medicine Physician | 207R00000X | 46512 | TN | |
| Nephrology Physician | 207RN0300X | 46512 | TN | Yes |
Addresses
Primary practice location
1325 Eastmoreland Ave Ste 445
Memphis, TN 38104-7536
Mailing address
1068 Cresthaven Rd Ste 300
Memphis, TN 38119-0809
Phone (901) 866-8748
Other practice location 1
7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (662) 772-2980
Other practice location 2
6019 Walnut Grove Rd
Memphis, TN 38120-2113
Phone (901) 226-3610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03001574 | Medicaid | MS | |
| 1524078 | Medicaid | TN | |
| 187456001 | Medicaid | AR |
Other names
- Omer Muhammad Asif Siddiqui
NPI Registry JSON
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752019200000",
"number": "1659577278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1068 CRESTHAVEN RD STE 300",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381190809",
"telephone_number": "901-866-8748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 EASTMORELAND AVE STE 445",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381047536",
"telephone_number": "901-866-8810",
"fax_number": "901-302-2450"
}
],
"practiceLocations": [
{
"address_1": "7601 Southcrest Pkwy",
"address_purpose": "LOCATION",
"city": "Southaven",
"state": "MS",
"postal_code": "386714739",
"country_code": "US",
"telephone_number": "662-772-2980",
"fax_number": "662-772-2960",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6019 Walnut Grove Rd",
"address_purpose": "LOCATION",
"city": "Memphis",
"state": "TN",
"postal_code": "381202113",
"country_code": "US",
"telephone_number": "901-226-3610",
"fax_number": "901-226-3612",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ASIF SIDDIQUI",
"first_name": "OMER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-21",
"last_updated": "2025-07-09",
"certification_date": "2025-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "23721",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AR",
"license": "E6551",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TN",
"license": "46512",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "TN",
"license": "46512",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03001574",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1524078",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "187456001",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "OMER",
"last_name": "ASIF SIDDIQUI",
"middle_name": "MUHAMMAD",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
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- Ashok Kara PHD PC
- Lasheryl Askew
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All providers in Memphis, TN · Nephrology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.