Individual provider Active NPI

Amir Bari Siddiqui, M.D.

  • Pediatric Hematology & Oncology Physician
  • Park Ridge, IL
National Provider Identifier
1720320526
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
036.138725 Issued in IL
Practice address
1775 Dempster St FL 2
Park Ridge, IL 60068
Phone
(847) 723-9400
Fax
(847) 723-8523
NPI assigned
Mar 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125.062594 IL
Pediatric Hematology & Oncology Physician 2080P0207X 036.138725 IL Primary

Addresses

Primary practice location

1775 Dempster St FL 2
Park Ridge, IL 60068

Mailing address

1775 Dempster St FL 2
Park Ridge, IL 60068-1143
Phone (847) 723-9400

Other practice location 1

5841 S Maryland Ave
MC 4060
Chicago, IL 60637-1447
Phone (773) 702-6808

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address asiddiqui248900@direct.myadvocateaurora.org Direct
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160823000186 IL Practitioner - Pediatric Medicine 0042511065 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.062594ILMDPediatrics Physician
036.138725ILMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince Apr 16, 2020 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Sep 19, 2016 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Sep 19, 2016 Accepting new patients
The University of Chicago Medical Center CurrentSince Apr 16, 2020 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

29373 Network Pl
Chicago, IL 60673

1775 W Dempster St
Fl 2
Park Ridge, IL 60068
Phone (847) 723-9400

1675 Dempster St
Fl 2
Park Ridge, IL 60068
Phone (847) 318-9330

Interoperability endpoints

  • Direct secure messaging: asiddiqui151645@uchospital.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1720320526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 DEMPSTER ST FL 2",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681143",
            "telephone_number": "847-723-9400",
            "fax_number": "847-723-8523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 DEMPSTER ST FL 2",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "847-723-9400",
            "fax_number": "847-723-8523"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5841 S Maryland Ave",
            "address_2": "MC 4060",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606371447",
            "country_code": "US",
            "telephone_number": "773-702-6808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "AMIR",
        "middle_name": "BARI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-20",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.062594",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "IL",
            "license": "036.138725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asiddiqui248900@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1775 Dempster St Fl 2",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60068",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1775 Dempster St Fl 2",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.