NPIMap

Organization Active NPI

McLean Foot Clinic,P.C.

  • Podiatrist
  • Harvard, IL
National Provider Identifier
1760437602
Registry record updated Dec 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
MCLEAN FOOT CLINIC,P.C.
Practice address
400 N Division St
Harvard, IL 60033-3061
Phone
(815) 943-7709
Fax
(847) 931-7726
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2007

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

Authorized official

Name
Dr. Irshad Ahmed Siddique, D.P.M.NPI 1700888187
Title
President
Phone
(815) 943-7709

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X IL Primary

Addresses

Primary practice location

400 N Division St
Harvard, IL 60033-3061

Mailing address

400 N Division St
Harvard, IL 60033-3061
Phone (815) 943-7709

Other identifiers 1

IdentifierTypeStateIssuer
0005632037,004454016OtherILBLUECROSS BLUESHIELD

Other names 1

  • Harvard Foot Clinic,P.C. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060524000190 IL Part B Supplier - Clinic/Group Practice 0648281055 Receives reassigned benefits from 2 practitioners
Practice locations: Elgin, IL; Harvard, IL

National Provider Directory

National Provider Directory

Locations

400 N Division St
Harvard, IL 60033
Phone (815) 943-7709

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197072000000",
    "number": "1760437602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N DIVISION ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600333061",
            "telephone_number": "815-943-7709",
            "fax_number": "847-931-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N DIVISION ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600333061",
            "telephone_number": "815-943-7709",
            "fax_number": "847-931-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEAN FOOT CLINIC,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2007-12-08",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUE",
        "authorized_official_first_name": "IRSHAD",
        "authorized_official_middle_name": "AHMED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-943-7709",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "0005632037,004454016",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harvard Foot Clinic,P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harvard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.