Active NPI
Nabeel Hassan Siddiqui, M.D.
- Pulmonary Disease Physician
- Pine Bluff, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- E-12999
- 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, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| E-12999 | AR | MD | Pulmonary Disease Physician |
| 125064226 | IL | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson Hospital Association, Inc | Current | Accepting new patients | |
| Jefferson Hospital Association, Inc | Pulmonary Disease | Current | Accepting new patients |
| Jefferson Hospital Assn, Inc. | Current | 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.
-
- Pulmonary Disease Physician
- Pine Bluff, AR
- NPI 1932157674
-
dba South Arkansas Cardiovascular Surgery Center
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Pine Bluff, AR
- NPI 1982940433
-
- Rural Health Clinic/Center
- Crossett, AR
- NPI 1225799646
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Jefferson Regional Medical Center
- General Acute Care Hospital
- Pine Bluff, AR
- NPI 1710931985
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.