NPIMap

Individual provider Active NPI

Khursheed A Siddiqui, MD

  • Pain Medicine Physician
  • Danville, KY
National Provider Identifier
1881634368
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
28741 Issued in KY
Practice address
300 West Broadway
Danville, KY 40422-1408
Phone
(859) 236-0606
Fax
(859) 236-0066
NPI assigned
Jun 6, 2006
Last updated
Dec 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 28741 KY
Pain Medicine (Anesthesiology) Physician 207LP2900X 28741 KY
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X 28741 KY
Pain Medicine Physician 208VP0000X 28741 KY Primary
Interventional Pain Medicine Physician 208VP0014X 28741 KY

Addresses

Primary practice location

300 West Broadway
Danville, KY 40422-1408

Mailing address

300 West Broadway
Danville, KY 40422-1408
Phone (859) 236-0606

Other practice location 1

800 Rose St
Lexington, KY 40536-1408
Phone (859) 323-5956

Other identifiers 1

IdentifierTypeStateIssuer
64287410MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20040802000679 KY Practitioner - AnesthesiologyPractitioner - Interventional Pain ManagementPractitioner - Pain ManagementPractitioner - Addiction MedicinePractitioner - Interventional Radiology 3779554050 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Eastern Virginia Medical School, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Family Medical Clinic Mount VernonGroup PAC ID 2062780810, 6 clinicians
Advanced Family Medical Clinic LibertyGroup PAC ID 3173891926, 5 clinicians

Practice addresses (Care Compare)

109 Daniel Dr
Danville, KY 40422-2527
Phone (859) 236-3361

120 Daniel Dr
Danville, KY 40422-2527
Phone (859) 239-5570

124 Daniel Dr
Danville, KY 40422-2527
Phone (859) 239-5570

130 Daniel Dr
Danville, KY 40422-2527
Phone (859) 236-2222

216 W Walnut St
Danville, KY 40422-1832

79 Sarahs LN
Somerset, KY 42503-2789
Phone (606) 392-2060

84 Hustonville St
Liberty, KY 42539-3469
Phone (606) 706-7473

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.36 of 100Reported as group
Quality
64.78
Promoting interoperability
100
Improvement activities
40
Cost
67.25

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28741KYMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Family Medical Clinic Liberty CurrentSince Jun 1, 2017 Accepting new patients
Ephraim McDowell Health Resource, Inc CurrentSince Jun 9, 2022 Accepting new patients
United Clinics of Kentucky LLC CurrentSince Feb 13, 2017 Accepting new patients
Ephraim McDowell Health Resource, Inc Anesthesiology CurrentSince Jun 9, 2022 Accepting new patients
Ephraim McDowell Health Resource, Inc. Current Accepting new patients
Advanced Family Medical Clinic Mount Vernon CurrentSince Jun 1, 2017 Accepting new patients
United Clinics of Kentucky LLC CurrentSince Feb 13, 2017 Accepting new patients
University of Kentucky CurrentSince Jan 1, 2022 Accepting new patients
Danville Anesthesia Associates, LLP Anesthesiology CurrentSince Jan 13, 1996 Accepting new patients
Center for Recovery and Wellness Addiction Medicine Past Accepting new patients
Danville Interventional Pain Pain Medicine Past Accepting new patients
Madar Bux, M.D., P.S.C. Anesthesiology Past Accepting new patients
Ephraim McDowell Health Resource,Inc Past Accepting new patients

Locations

109 Daniel Dr
Danville, KY 40422
Phone (859) 236-3361

1541 Lebanon Rd
Ste 1
Danville, KY 40422
Phone (859) 236-3208

216 W Walnut St
Ste A
Danville, KY 40422
Phone (859) 239-5870

217 S 3rd St
Danville, KY 40422
Phone (859) 239-1000

359 S 4th St
Ste D
Danville, KY 40422
Phone (606) 236-3726

2353 Alexandria Dr
Ste 350
Lexington, KY 40504
Phone (859) 224-2655

2400 Greatstone Pt
Lexington, KY 40504
Phone (859) 257-9800

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

84 Hustonville St
Liberty, KY 42539
Phone (606) 706-7473

79 Sarahs Ln
Somerset, KY 42503
Phone (606) 386-1917

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Advanced Family Medical Clinic LibertyLiberty, KY, CCN 188970 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 May 15, 2017
May 15, 2017
May 15, 2017
May 15, 2017
Advanced Family Medical ClinicSomerset, KY, CCN 188971 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 May 15, 2017
May 15, 2017
May 15, 2017
May 15, 2017

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 8

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1881634368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WEST BROADWAY",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404221408",
            "telephone_number": "859-236-0606",
            "fax_number": "859-236-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WEST BROADWAY",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404221408",
            "telephone_number": "859-236-0606",
            "fax_number": "859-236-0066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Rose St",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405361408",
            "country_code": "US",
            "telephone_number": "859-323-5956",
            "fax_number": "859-323-1080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "KHURSHEED",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "28741",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "KY",
            "license": "28741",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "KY",
            "license": "28741",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "KY",
            "license": "28741",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "KY",
            "license": "28741",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64287410",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, KY

Sources for this page

Verify at the official NPI Registry.