NPIMap

Individual provider Active NPI

Shoab Siddique, M.D.

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Sacramento, CA
National Provider Identifier
1972614436
Registry record updated Feb 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
A71415 Issued in CA
Practice address
3000 Q St
Sacramento, CA 95816-7058
Phone
(916) 733-3333
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X A71415 CA Primary

Addresses

Primary practice location

3000 Q St
Sacramento, CA 95816-7058

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

Other identifiers 12

IdentifierTypeStateIssuer
000810579445OtherCAPHCS
1837078OtherCAFIRST HEALTH
44530OtherCAINTERPLAN
7494423OtherCACIGNA
00A714150MedicaidCA
7796146OtherCAAETNA
1294175OtherCAGREAT WEST
A71415OtherCABLUE CROSS
079115OtherCAHEALTH NET
1968751OtherCAUNITED HEALTHCARE
90138939OtherCAPACIFICARE
MCMG298400OtherCAWESTERN HEALTH ADVANTAGE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040212000764 CA Practitioner - Otolaryngology 4981598521 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

3000 Q St
FL 5
Sacramento, CA 95816-7058
Phone (916) 560-0319

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Feb 9, 2004 Accepting new patients
Dignity Health Medical Foundation CurrentSince Feb 9, 2004 Accepting new patients
Sutter North Medical Foundatoin Past Accepting new patients
Dignity Health Medical Foundation Past Accepting new patients
Rideout Memorial Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Methodist Healthcare System of San Antonio, LTD., L.L.P. Past Accepting new patients
Dignity Community Care Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

3000 Q St
Fl 5
Sacramento, CA 95816
Phone (916) 733-3312

3000 Q St
Sacramento, CA 95816
Phone (916) 733-5701

Interoperability endpoints

  • Direct secure messaging: ssiddique248142@hisp.ehr.sutterhealth.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329091200000",
    "number": "1972614436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167058",
            "telephone_number": "916-733-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUE",
        "first_name": "SHOAB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "CA",
            "license": "A71415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "000810579445",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1837078",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERPLAN",
            "identifier": "44530",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7494423",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A714150",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7796146",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST",
            "identifier": "1294175",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "A71415",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "079115",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1968751",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFICARE",
            "identifier": "90138939",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WESTERN HEALTH ADVANTAGE",
            "identifier": "MCMG298400",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.