NPIMap

Individual provider Active NPI

Omer Asif Siddiqui, M.D.

  • Nephrology Physician
  • Memphis, TN
National Provider Identifier
1659577278
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
46512 Issued in 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
Last updated
Jul 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 23721 MS
Internal Medicine Physician 207R00000X E6551 AR
Internal Medicine Physician 207R00000X 46512 TN
Nephrology Physician 207RN0300X 46512 TN Primary

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 names 1

  • Omer Muhammad Asif Siddiqui Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110616000804 TN Practitioner - NephrologyPractitioner - Internal Medicine 6305030768 Reassigns benefits to 3 organizations
I20151207000905 MS Practitioner - NephrologyPractitioner - Internal Medicine 6305030768 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Medical Group IncGroup PAC ID 3173435369, 98 clinicians
Greenbrook Physician Services, LLCGroup PAC ID 5597267427, 70 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
88.15 of 100Reported as group
Quality
59.97
Promoting interoperability
100
Improvement activities
40
Cost
80.93

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E6551ARMDInternal Medicine Physician
23721MSMDInternal Medicine Physician
46512TNMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Internal Medicine CurrentSince Jan 1, 2014 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

  • Direct secure messaging: osiddiqui14528@direct.bmhcc.org
  • Direct secure messaging: osiddiqui45566@mlh.direct-ci.com

Organizations & group practices 5

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.

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": "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": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OMER",
            "last_name": "ASIF SIDDIQUI",
            "middle_name": "MUHAMMAD",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.