Jawed H. Siddiqui, M.D.
Individual provider Active NPI Internal Medicine Physician · Florissant, MO
NPI 1699705293 · NPPES record last updated Jun 20, 2008
Key facts
- NPI
- 1699705293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- R6047 (MO)
- Practice address
- 11115 New Halls Ferry Rd
Suites 301-302
Florissant, MO 63033-7613 - Phone
- (314) 921-6200
- Fax
- (314) 830-0756
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 22
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1970
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Post Acute Medical PLLC
The Health Centers PC
JN Wellness Inc
Practice addresses (Care Compare)
11115 New Halls Ferry Rd
Suite 105
Florissant, MO 63033-7610
Phone (314) 921-6200
1441 Charic Dr
Wildwood, MO 63021-2001
Phone (636) 394-2522
2621 Raymond Dr
Saint Charles, MO 63301-4872
Phone (636) 946-2244
4225 Bayless Ave
Saint Louis, MO 63123-7513
Phone (314) 544-5600
Hospital & facility affiliations
- Mercy Hospital St Louis
- Bria of Godfrey
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, IL
- 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 |
|---|---|---|---|---|
| I20040701000288 | MO | Practitioner - Internal Medicine |
5799762415 | Reassigns benefits to 8 organizations |
| I20081125000761 | IL | Practitioner - Internal Medicine |
5799762415 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-056278 | IL | MD | Internal Medicine Physician |
| R6047 | MO | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Post Acute Medical PLLC | Internal Medicine | Current |
Accepting new patients |
| The Health Centers, P.C. | Current |
Accepting new patients | |
| Metro Medical North County LLC | Internal Medicine | Current |
Accepting new patients |
| Metro Cardiovascular, Inc. | Internal Medicine | Current |
Accepting new patients |
| Altea Medical Missouri LLC | Internal Medicine | Current |
Accepting new patients |
| Metro Medical Institute | Current |
Accepting new patients | |
| Altea Medical Illinois PLLC | Internal Medicine | Current |
Accepting new patients |
| JN Wellness Inc | Current |
Accepting new patients | |
| St Louis Medical Center Inc | Current |
Accepting new patients | |
| Clinical Medical Services LLC | Internal Medicine | Current |
Accepting new patients |
| Dr. David a Sciortino, LTD | Current |
Accepting new patients | |
| Charic Dr Healthcare LLC | Past | Accepting new patients | |
| Bermuda Drive Healthcare LLC | Past | Accepting new patients | |
| Medical Care LLC | Past | Accepting new patients | |
| Altea Medical Alaska LLC | Internal Medicine | Past | Accepting new patients |
| Midwest Laboratory Services LLC | Past |
Accepting new patients | |
| Redman Rd Healthcare LLC | Past | Accepting new patients | |
| Clayton Road Healthcare LLC | Past | Accepting new patients | |
| Clay Street Healthcare LLC | Past | Accepting new patients | |
| Saint Louis Connectcare | Past | Accepting new patients | |
| Aim Xpress Medical Care LLC | Past |
Accepting new patients | |
| McCutchen Rd Healthcare LLC | Past | Accepting new patients |
Locations (25 of 30)
400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297
205 Bailey Ln
Benton, IL 62812
Phone (618) 435-8189
490 W 16th Pl
Chicago Hts, IL 60411
Phone (708) 481-4444
3354 Jerome Ln
East Saint Louis, IL 62206
Phone (618) 337-9400
3116 State St
#2
East Saint Louis, IL 62205
Phone (618) 857-2111
1101 E State St
Geneva, IL 60134
Phone (630) 208-1876
2044 Madison Ave
Ste G2
Granite City, IL 62040
Phone (314) 549-8494
555 W Carpenter St
Springfield, IL 62702
Phone (217) 525-1880
14 Park Pl
Ste B
Swansea, IL 62226
Phone (314) 685-8721
12174 Natural Bridge Rd
Bridgeton, MO 63044
Phone (314) 481-3037
11115 New Halls Ferry Rd
Florissant, MO 63033
Phone (314) 283-0976
11115 New Halls Ferry Rd
Ste 300
Florissant, MO 63033
Phone (314) 395-8927
11115 New Halls Ferry Rd
#301302
Florissant, MO 63033
Phone (314) 921-6200
11115 New Halls Ferry Rd
Ste Suites
Florissant, MO 63033
11115 New Halls Ferry Rd
Ste 105
Florissant, MO 63033
Phone (314) 499-6060
11115 New Halls Ferry Rd
Ste 201
Florissant, MO 63033
Phone (314) 283-3393
11115 New Halls Ferry Rd
Ste 301
Florissant, MO 63033
Phone (314) 921-6200
430 N West St
Perryville, MO 63775
Phone (273) 547-1011
2621 Raymond Dr
Saint Charles, MO 63301
Phone (636) 946-2244
4225 Bayless Ave
Saint Louis, MO 63123
Phone (314) 544-5600
777 Craig Rd
Ste 200
Saint Louis, MO 63141
Phone (314) 549-8494
4116 Von Talge Rd
Ste B
Saint Louis, MO 63128
Phone (314) 822-5175
3535 S Jefferson Ave
Saint Louis, MO 63118
Phone (314) 260-9560
777 Craig Rd
Ste 135A
Saint Louis, MO 63141
Phone (314) 453-9300
7721 Clayton Rd
Saint Louis, MO 63117
Phone (314) 546-6072
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | R6047 | MO | Yes |
| Internal Medicine Physician | 207R00000X | 036-056278 | IL |
Addresses
Primary practice location
11115 New Halls Ferry Rd
Suites 301-302
Florissant, MO 63033-7613
Mailing address
1415 Topping Rd
Saint Louis, MO 63131-1424
Phone (314) 984-9213
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110125678 | Other | MO | RAILROAD MEDICARE |
| 7040870018 | Medicaid | IL | |
| 200668739 | Medicaid | MO |
Other providers in Florissant, MO
- Shining Star ABA
- Raj Shivaji
- Barbara Ann Short
- Aleksandr Shoykhet
- Sonja Sickels
- Michael Dorian Siebe II
- Silent Care LLC
- Andrea Simmons
- Kecia Simmons
- Abigail Simon
All providers in Florissant, MO · Internal Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2008. 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.