NPIMap

Individual provider Active NPI

Mumtaz A Siddiqui, M.D.

  • Cardiovascular Disease Physician
  • Normal, IL
National Provider Identifier
1679569925
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Practice address
1302 Franklin Ave
Suite 4500
Normal, IL 61761-3551
Phone
(309) 828-1166
NPI assigned
Sep 22, 2005
Last updated
Feb 27, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X IL Primary

Addresses

Primary practice location

1302 Franklin Ave
Suite 4500
Normal, IL 61761-3551

Mailing address

1302 Franklin Ave
Suite 4500
Normal, IL 61761-3551
Phone (309) 828-1166

Other identifiers 2

IdentifierTypeStateIssuer
05732097OtherILBCBS GROUP NUMBER
212636OtherILMEDICARE GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040924000638 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Cardiac Electrophysiology 6608845896 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Cardiac Electrophysiology, Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

26 W171 Roosevelt Rd
Wheaton, IL 60187-6002
Phone (630) 909-8000

365 E N Ave
Northlake, IL 60164-2628
Phone (708) 345-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
60 of 100Reported as individual
Quality
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-107013ILMDCardiovascular Disease Physician
36720WIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
KND Development 59 LLC CurrentSince Jun 3, 2018 Accepting new patients
Loretto Hospital Current Accepting new patients
KND Development 59, LLC CurrentSince Jun 3, 2018 Accepting new patients
KND Development 59 LLC Current Accepting new patients
Premier Cardiovascular Associates Inc Cardiovascular Disease CurrentSince Feb 9, 2013 Accepting new patients
Bromenn Physician Management Corporation Cardiovascular Disease Past Accepting new patients
Metropolitan Cardiovascular Associates LLC Cardiovascular Disease PastSince Jul 1, 2008 Accepting new patients
Cardiology Physicians, LLC Cardiovascular Disease Past Accepting new patients

Locations

760 Village Center Dr
Ste 220
Burr Ridge, IL 60527
Phone (630) 242-6644

2544 W Montrose Ave
Chicago, IL 60618
Phone (773) 267-2622

5025 N Paulina St
Chicago, IL 60640
Phone (773) 271-9040

6130 N Sheridan Rd
Chicago, IL 60660
Phone (773) 381-1222

701 Winthrop Ave
Glendale Hts, IL 60139
Phone (630) 312-2000

130 S Main St
Ste 304
Lombard, IL 60148
Phone (630) 481-6161

150 W High St
Morris, IL 60450
Phone (815) 942-2129

1730 Park St
Ste 101
Naperville, IL 60563
Phone (630) 718-0200

365 E North Ave
Northlake, IL 60164
Phone (517) 273-1540

225 Edward St
Sycamore, IL 60178
Phone (815) 225-2144

26W171 Roosevelt Rd
Wheaton, IL 60187
Phone (630) 462-4000

Interoperability endpoints

  • Direct secure messaging: mumtaz.siddiqui@loretto.medalliesdirect.net

Organizations & group practices 8

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 6

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": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204070400000",
    "number": "1679569925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 FRANKLIN AVE",
            "address_2": "SUITE 4500",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613551",
            "telephone_number": "309-828-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 FRANKLIN AVE",
            "address_2": "SUITE 4500",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613551",
            "telephone_number": "309-828-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "MUMTAZ",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2008-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "05732097",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "212636",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.