NPIMap

Individual provider Active NPI

Masood Siddiquee, MD

  • Internal Medicine Physician
  • Conyers, GA
National Provider Identifier
1871551788
Registry record updated Jun 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
047154 Issued in GA
Practice address
2080 Eastside Drive
Suite a
Conyers, GA 30013
Phone
(678) 625-7800
Fax
(678) 625-7888
NPI assigned
May 2, 2006
Last updated
Jun 21, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 047154 GA Primary

Addresses

Primary practice location

2080 Eastside Drive
Suite a
Conyers, GA 30013

Mailing address

2080 Eastside Drive
Suite a
Conyers, GA 30013
Phone (678) 625-7800

Other identifiers 1

IdentifierTypeStateIssuer
000821939BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091203000457 GA Practitioner - Internal Medicine 1153375308 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastside Internal Medicine, LLCGroup PAC ID 7618921867, 3 clinicians

Practice addresses (Care Compare)

2080 Eastside Dr
Suite a
Conyers, GA 30013-1953
Phone (678) 625-7800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group Georgia Inc Internal Medicine CurrentSince Jan 20, 2014 Accepting new patients
Hospital Physician Services - Southeast Professional Corporation CurrentSince Jan 1, 2015 Accepting new patients
24 On Physicians, P.C. CurrentSince Sep 29, 2009 Accepting new patients
24 On Physicians, PC CurrentSince Sep 29, 2009 Accepting new patients
Eastside Internal Medicine, LLC CurrentSince Jan 1, 2003 Accepting new patients
Eastside Internal Medicine, LLC Internal Medicine Past Accepting new patients

Locations

13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

2080 Eastside Dr
Ste A
Conyers, GA 30013
Phone (678) 625-7800

304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000

501 Redmond Rd NW
Rome, GA 30165
Phone (706) 291-0291

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1871551788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 EASTSIDE DRIVE",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30013",
            "telephone_number": "678-625-7800",
            "fax_number": "678-625-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 EASTSIDE DRIVE",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30013",
            "telephone_number": "678-625-7800",
            "fax_number": "678-625-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUEE",
        "first_name": "MASOOD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "047154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000821939B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.