Batool Summer Siddiqui, CPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

1982 Issued in TX

Practice address

99 Cheek Sparger Rd Ste 104a
Colleyville, TX 76034-2204

Phone

(682) 390-4499

Fax

(817) 549-9460

NPI assigned

Jun 12, 2019

Last updated

Nov 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Kavella Prosthetics and Orthotics LLC

  • Prosthetic/Orthotic Supplier
  • Colleyville, TX
  • NPI 1801503735

  Orthotist

  NPD Authorized official

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1922667948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 CHEEK SPARGER RD STE 104A",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760342204",
            "telephone_number": "682-390-4499",
            "fax_number": "817-549-9460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 CHEEK SPARGER RD STE 104A",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760342204",
            "telephone_number": "682-390-4499",
            "fax_number": "817-549-9460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "BATOOL",
        "middle_name": "SUMMER",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-12",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "TX",
            "license": "1982",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "TX",
            "license": "1982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CPO",
            "identifier": "04188",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DEPARTMENT OF LICENSING & REGULATION",
            "identifier": "1982",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kavellapo@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "99 Cheek Sparger Rd Ste 104A",
            "city": "Colleyville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760342204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetist in Colleyville, TX
• Providers in Colleyville, TX by specialty
• Prosthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.