NPIMap

Individual provider Active NPI

Mahboob Ali, MD

  • Interventional Cardiology Physician
  • Stockton, CA
National Provider Identifier
1134477599
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
A147096 Issued in CA
Practice address
1801 E March LN Ste A170
Stockton, CA 95210-6673
Phone
(209) 951-9884
NPI assigned
Aug 16, 2012
Last updated
Jul 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 052353 CT
Hospitalist Physician 208M00000X 052353 CT
Interventional Cardiology Physician 207RI0011X A147096 CA Primary

Addresses

Primary practice location

1801 E March LN Ste A170
Stockton, CA 95210-6673

Mailing address

PO Box 255228
Sacramento, CA 95865-5228
Phone (855) 771-0335

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
I20200729003563 CA Practitioner - Cardiovascular Disease (Cardiology) 1254561285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

1011 Sylvan Ave
Suite C
Modesto, CA 95350-1693
Phone (209) 550-4780

1409 E Briggsmore Ave
Modesto, CA 95355-2707
Phone (209) 524-1211

1700 Coffee Rd
Modesto, CA 95355-2803
Phone (209) 526-4500

2505 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2545 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2800 L St
Sacramento, CA 95816-5616

815 Court St
Jackson, CA 95642-2154

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting13
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Internal Medicine Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Aug 10, 2020 Accepting new patients
Sutter Valley Medical Foundation Internal Medicine CurrentSince Aug 10, 2020 Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
PHC-Las Cruces Inc Past Accepting new patients

Locations

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

999 S Fairmont Ave
Ste 130
Lodi, CA 95240
Phone (209) 334-3377

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

1801 E March Ln
Ste A170
Stockton, CA 95210
Phone (209) 477-5552

2545 W Hammer Ln
Stockton, CA 95209
Phone (209) 948-1641

Interoperability endpoints

  • Direct secure messaging: mali549481@hisp.ehr.sutterhealth.org

Organizations & group practices 7

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 7

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": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1134477599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228",
            "telephone_number": "855-771-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN STE A170",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106673",
            "telephone_number": "209-951-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALI",
        "first_name": "MAHBOOB",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-16",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "052353",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "052353",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A147096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.