Individual provider Active NPI

Nabeel Hassan Siddiqui, M.D.

  • Pulmonary Disease Physician
  • Pine Bluff, AR
National Provider Identifier
1902228810
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
E-12999 Issued in AR
Practice address
1609 W 40TH Ave Ste 202a
Pine Bluff, AR 71603-6367
Phone
(870) 541-7211
NPI assigned
Jan 11, 2014
Last updated
Mar 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125064226 IL
Pulmonary Disease Physician 207RP1001X E-12999 AR Primary

Addresses

Primary practice location

1609 W 40TH Ave Ste 202a
Pine Bluff, AR 71603-6367

Mailing address

PO Box 2650
Pine Bluff, AR 71613-2650
Phone (870) 541-7211

Other practice location 1

355 Ridge Ave
Evanston, IL 60202-3328
Phone (847) 316-4000

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address siddiquin@ohit.sharear.net Jefferson Hospital Association, Inc
Direct Messaging Address siddiquin@ohit.sharear.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20200715002345 AR Practitioner - Internal MedicinePractitioner - Pulmonary Disease 2961767090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pulmonary Disease
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1609 W 40TH Ave
Suite 202a
Pine Bluff, AR 71603-6367
Phone (870) 541-4280

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-12999ARMDPulmonary Disease Physician
125064226ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Hospital Association, Inc CurrentSince Jul 1, 2020 Accepting new patients
Jefferson Hospital Association, Inc Pulmonary Disease Current Accepting new patients
Jefferson Hospital Assn, Inc. CurrentSince Jul 1, 2020 Accepting new patients

Locations

1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100

1601 W 40th Ave
Ste 301
Pine Bluff, AR 71603
Phone (870) 541-4285

1609 W 40th Ave
Ste 202A
Pine Bluff, AR 71603
Phone (870) 541-4280

1609 W 40th Ave
Ste 403
Pine Bluff, AR 71603
Phone (870) 534-4188

Organizations & group practices 3

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 1

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": "1389398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1902228810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716132650",
            "telephone_number": "870-541-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE STE 202A",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036367",
            "telephone_number": "870-541-7211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 Ridge Ave",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602023328",
            "country_code": "US",
            "telephone_number": "847-316-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "NABEEL",
        "middle_name": "HASSAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-11",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125064226",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AR",
            "license": "E-12999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "siddiquin@ohit.sharear.net",
            "affiliation": "Y",
            "affiliationName": "Jefferson Hospital Association, Inc",
            "address_1": "1601 W 40th Ave",
            "address_2": "Suite 301",
            "city": "Pine Bluff",
            "state": "AR",
            "country_code": "US",
            "postal_code": "716036319",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "siddiquin@ohit.sharear.net",
            "affiliation": "N",
            "address_1": "1601 W 40th Ave",
            "address_2": "Suite 301",
            "city": "Pine Bluff",
            "state": "AR",
            "country_code": "US",
            "postal_code": "716036319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.