NPIMap

Organization Active NPI

Hamdard Health Alliance

  • Federally Qualified Health Center (FQHC)
  • Bensenville, IL
National Provider Identifier
1700470580
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HAMDARD HEALTH ALLIANCE
Practice address
1240 Busse Rd
Bensenville, IL 60106-1034
Phone
(224) 414-1390
Fax
(224) 414-1290
NPI assigned
Feb 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Authorized official

Name
Shawn Bailey
Title
Finance Administration Manager
Phone
(630) 835-1430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1240 Busse Rd
Bensenville, IL 60106-1034

Mailing address

228 E Lake St
Addison, IL 60101-2889
Phone (630) 835-1430

Other identifiers 1

IdentifierTypeStateIssuer
781988OtherILPART A

Other names 2

  • Hamdard Health Bensenville Doing business as
  • Hamdard Center for Health and Human Services, NFP Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040421001679 IL Part B Supplier - Clinic/Group Practice 4880680289 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Addison, IL; Chicago, IL
O20211028000069 IL Part A Provider - Federally Qualified Health Center (FQHC) 4880680289 Practice locations: Bensenville, IL

Federally qualified health center certification: CCN 781988

Legal name
HAMDARD HEALTH ALLIANCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 2021
Last certification
Nov 12, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 2021 in IL
Enrollment address
1240 Il Route 83
Bensenville, IL 60106-1034

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

228 E Lake St
Ste 301
Addison, IL 60101
Phone (630) 835-1430

1240 Il Route 83
Bensenville, IL 60106
Phone (224) 414-1390

49 N Kedzie Ave
Chicago, IL 60612
Phone (773) 509-9099

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kiran Siddiqui Individual Corporate OfficerCeo Jan 1, 2020
W-2 Managing EmployeeCeo Jan 1, 2020
Serifa Huskic Individual W-2 Managing Employee Jan 1, 2021
Raiesa Abdul Samad Individual Corporate DirectorBoard Member Jan 1, 2020
Adnaan Hamid Individual Corporate DirectorBoard Member Jan 1, 2020
Carmelia Love Individual W-2 Managing Employee Mar 23, 2021
Lance Wicks Individual Corporate OfficerCfo Jan 1, 2020
W-2 Managing EmployeeCfo Jan 1, 2020
Operational/Managerial ControlCfo Jan 1, 2020
Nauman Shaikh Individual Corporate DirectorBoard Member Jan 1, 2020

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703548800000",
    "number": "1700470580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 E LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601012889",
            "telephone_number": "630-835-1430",
            "fax_number": "630-835-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 BUSSE RD",
            "city": "BENSENVILLE",
            "state": "IL",
            "postal_code": "601061034",
            "telephone_number": "224-414-1390",
            "fax_number": "224-414-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMDARD HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-23",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "FINANCE ADMINISTRATION MANAGER",
        "authorized_official_telephone_number": "630-835-1430"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART A",
            "identifier": "781988",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hamdard Health Bensenville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hamdard Center for Health and Human Services, NFP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Hamdard Center for Health and Human Services, NFP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bensenville, IL

Sources for this page

Verify at the official NPI Registry.