NPIMap

Individual provider Active NPI

Kamran Fasih Siddiqui, M.D.

  • Internal Medicine Physician
  • Elkhart, IN
National Provider Identifier
1871596700
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01059787A Issued in IN
Practice address
303 S Nappanee St
Elkhart, IN 46514-2066
Phone
(574) 296-3307
Fax
(574) 296-3309
NPI assigned
May 24, 2005
Last updated
Jun 17, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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 01059787A IN Primary

Addresses

Primary practice location

303 S Nappanee St
Elkhart, IN 46514-2066

Mailing address

PO Box 2968
Elkhart, IN 46515-2968
Phone (574) 296-3200

Other identifiers 1

IdentifierTypeStateIssuer
200464260MedicaidIN

Other names 1

  • Dr. Kamran Fasih Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20041108000778 IN Practitioner - Internal Medicine 7810883238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group Indiana LLCGroup PAC ID 2365341674, 28 clinicians

Practice addresses (Care Compare)

2115 W Lexington Ave
Elkhart, IN 46514-1423
Phone (574) 296-3955

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01059787AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Indiana, LLC CurrentSince Dec 15, 2004 Accepting new patients
Privia Medical Group Indiana, LLC Current Accepting new patients
Appalachian Regional Healthcare, Inc. Past Accepting new patients
Appalachian Regional Healthcare, Inc Past Accepting new patients
Appalachian Regional Healthcare, Inc Past Accepting new patients

Locations

2115 W Lexington Ave
Elkhart, IN 46514
Phone (574) 296-3437

303 S Nappanee St
Elkhart, IN 46514

Interoperability endpoints

  • Direct secure messaging: kamran.fasih.siddiqui.1@31626.direct.athenahealth.com
  • Direct secure messaging: kamran.fasihsiddiqui@elkhartc.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
East Lake Nursing & Rehabilitation CenterElkhart, IN, CCN 155269 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 14, 2020
Mar 31, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1871596700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152968",
            "telephone_number": "574-296-3200",
            "fax_number": "574-296-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S NAPPANEE ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142066",
            "telephone_number": "574-296-3307",
            "fax_number": "574-296-3309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "KAMRAN",
        "middle_name": "FASIH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01059787A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200464260",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAMRAN",
            "last_name": "FASIH",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.