NPIMap

Individual provider Active NPI

Parveen N Siddiqui, MD

  • Internal Medicine Physician
  • Saint Clair Shores, MI
National Provider Identifier
1689672024
Registry record updated Apr 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
PS076755 Issued in MI
Practice address
23411 Jefferson Ave
Suite 100
Saint Clair Shores, MI 48080-1949
Phone
(586) 778-4080
Fax
(586) 778-6055
NPI assigned
Jul 11, 2005
Last updated
Apr 29, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X PS076755 MI Primary

Addresses

Primary practice location

23411 Jefferson Ave
Suite 100
Saint Clair Shores, MI 48080-1949

Mailing address

PO Box 673215
Detroit, MI 48267-3215
Phone (586) 778-4080

Other identifiers 1

IdentifierTypeStateIssuer
4240936MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20101207000889 MI Practitioner - Internal Medicine 9931396629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17141 Kercheval Ave
Grosse Pointe, MI 48230-1660
Phone (313) 642-4990

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PS076755MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Feb 1, 2014 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine CurrentSince Feb 1, 2014 Accepting new patients
Henry Ford Cornerstone Medical Group Current Accepting new patients
St Clair Adult Medicine Specialists PC Internal Medicine Past Accepting new patients
St Clair Adult Medicine PC Internal Medicine Past Accepting new patients
Henry Ford Health St. John Hospital Internal Medicine Past Accepting new patients

Locations

42645 Garfield Rd
Ste 103
Clinton Twp, MI 48038
Phone (586) 286-0050

17141 Kercheval Ave
Grosse Pointe, MI 48230
Phone (313) 642-4980

46591 Romeo Plank Rd
Macomb, MI 48044
Phone (586) 226-6269

23411 Jefferson Ave
Ste 100
St Clr Shores, MI 48080
Phone (586) 299-1123

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/mQjCqHb5rkr1u1foU4dqhQPBpi7Qk9R4/
  • Direct secure messaging: psiddiqui1151300@direct.hfhs.org

Organizations & group practices 7

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 9

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": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240963200000",
    "number": "1689672024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673215",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482673215",
            "telephone_number": "586-778-4080",
            "fax_number": "586-778-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23411 JEFFERSON AVE",
            "address_2": "SUITE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801949",
            "telephone_number": "586-778-4080",
            "fax_number": "586-778-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "PARVEEN",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-11",
        "last_updated": "2009-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "PS076755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4240936",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.