NPIMap

Individual provider Active NPI

Mohammed Mahmood Ali, M.D.

  • Family Medicine Physician
  • Lake Forest, CA
National Provider Identifier
1053405506
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A83688 Issued in CA
Practice address
23672 Birtcher Dr
Unit a
Lake Forest, CA 92630-1711
Phone
(949) 770-7301
Fax
(949) 770-0634
NPI assigned
Oct 2, 2006
Last updated
Jan 26, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A83688 CA Primary

Addresses

Primary practice location

23672 Birtcher Dr
Unit a
Lake Forest, CA 92630-1711

Mailing address

23672 Birtcher Dr
Unit a
Lake Forest, CA 92630-1711
Phone (949) 770-7301

Other identifiers 1

IdentifierTypeStateIssuer
00A836880MedicaidCA

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
I20040726001379 CA Practitioner - Family Practice 6204806540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

665 Camino de Los Mares
Suite 203a
San Clemente, CA 92673-2859
Phone (949) 493-9344

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
38.51 of 100Reported as individual
Quality
30
Improvement activities
0
Cost
71.7

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A83688CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Wellness Center, Inc. Family Medicine CurrentSince Jul 24, 2008 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
GN Medical Associates, Inc. Family Medicine PastSince Apr 1, 2007 Accepting new patients
Queen of the Valley Medical Association Past Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients
Inez G. Fabella, M.D., Inc. Past Accepting new patients

Locations

23672 Birtcher Dr
Unit A
Lake Forest, CA 92630
Phone (949) 770-7301

665 Camino de los Mares
Ste 203A
San Clemente, CA 92673
Phone (949) 363-3456

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBDCDD/Endpoint/GBDCDD

Organizations & group practices 6

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 5

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422230400000",
    "number": "1053405506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23672 BIRTCHER DR",
            "address_2": "UNIT A",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301711",
            "telephone_number": "949-770-7301",
            "fax_number": "949-770-0634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23672 BIRTCHER DR",
            "address_2": "UNIT A",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301711",
            "telephone_number": "949-770-7301",
            "fax_number": "949-770-0634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALI",
        "first_name": "MOHAMMED",
        "middle_name": "MAHMOOD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A83688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A836880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

Verify at the official NPI Registry.