Physician Compare National (NPI:1659577278)

HEALTHCARE PROVIDER: OMER ASIF SIDDIQUI M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1659577278
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6305030768
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110616000804
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SIDDIQUI
	Individual professional last name
Provider First Name	OMER
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	UT MEDICAL GROUP, INC.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3173435369
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	98
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	930 MADISON AVE
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	MEMPHIS
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	381033410
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	440048
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440049
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	METHODIST HEALTHCARE MEMPHIS HOSPITALS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	250141
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BAPTIST MEMORIAL HOSPITAL DESOTO
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	440183
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST FRANCIS HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	250167
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1659577278)

HEALTHCARE PROVIDER: OMER ASIF SIDDIQUI M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information