Gulam M. T. Siddiqui, M. D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036-072949 Issued in IL

Practice address

800 School St
Carrollton, IL 62016-1436

Phone

(217) 942-6946

Fax

(217) 942-9349

NPI assigned

Jan 19, 2007

Last updated

May 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General PracticeAlso: Emergency Medicine, Family Practice

Education

Rush Medical College of Rush University, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanburg Emergency Group, P.C.Group PAC ID 4688003957, 12 clinicians

Thomas H Boyd Memorial HospitalGroup PAC ID 8123085560, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Thomas H Boyd Memorial Hospital Hospital, Carrollton, IL, CCN 141300
• Carlinville Area Hospital Hospital, Carlinville, IL, CCN 141347

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gulam.siddiqui.d2.p1@direct.boydrhcs.nextgenshare.com

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.

• Sanburg Emergency Group, P.C.

  • Emergency Medicine Physician
  • Galesburg, IL
  • NPI 1992337000
  Medicare reassignment Care Compare group NPD
• Thomas H. Boyd Memorial Hospital

  • Critical Access Hospital
  • Carrollton, IL
  • NPI 1811096811
  Medicare reassignment Care Compare group NPD
• Thomas H. Boyd Memorial Hospital

  dba Thomas H. Boyd Rural Health Clinic

  • Rural Health Clinic/Center
  • Carrollton, IL
  • NPI 1164507604
  NPD
• Thomas H. Boyd Memorial Hospital

  • Skilled Nursing Facility
  • Carrollton, IL
  • NPI 1699973685
  NPD
• Pine Ridge Indian Health Service Hospital

  dba Wanblee Health Center

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD (past)
• Public Hospital District No 1 of Mason County

  dba Mason Health-Mason General Hospital

  • Critical Access Hospital
  • Shelton, WA
  • NPI 1760568752
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carlinville Area Hospital Association

  dba Carlinville Area Hospital

  • Critical Access Hospital
  • Carlinville, IL
  • NPI 1053425124
  Care Compare affiliation
• Thomas H. Boyd Memorial Hospital

  • Critical Access Hospital
  • Carrollton, IL
  • NPI 1811096811
  Care Compare affiliation

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1720131188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 ASPEN DR",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484254",
            "telephone_number": "630-935-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCHOOL ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161436",
            "telephone_number": "217-942-6946",
            "fax_number": "217-942-9349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "GULAM",
        "middle_name": "M. T.",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-072949",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036072949",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Ricklefs, OTR/L
• Ethan Ridenour, COTA/L
• Roger a. Schroeder MD SC
• Allison N Sagez, FNP-C
• Laureca Schofield
• Mohammed W Siddiqui, M.D.
• Jonnelle D Smith, PA
• Morgan Stein, DPT
• Keli Stewart, NP
• William B Sturm, P.A.

• Emergency Medicine Physician in Carrollton, IL
• Providers in Carrollton, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.