Mahboob Ali, MD
Individual provider Active NPI Interventional Cardiology Physician · Stockton, CA
NPI 1134477599 · NPPES record last updated Jul 28, 2020
Key facts
- NPI
- 1134477599
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Interventional Cardiology Physician 207RI0011X
- License
- A147096 (CA)
- Practice address
- 1801 E March LN Ste A170
Stockton, CA 95210-6673 - Phone
- (209) 951-9884
- NPI assigned
- Aug 16, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 29
Hospital & facility affiliations 7
Medicare Care Compare profile
- 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 Foundation
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
- St Joseph'S Medical Center of Stockton
- Dameron Hospital
- Memorial Medical Center
- Sutter Amador Hospital
- Adventist Health Lodi Memorial
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary angioplasty and stenting | 13 |
| Pacemaker insertion or repair | 1-10 |
| Leg revascularization (restoring blood flow) | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200729003563 | CA | Practitioner - Cardiovascular Disease (Cardiology) | 1254561285 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A147096 | CA | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Valley Medical Foundation | Internal Medicine | Current | Accepting new patients |
| Sutter Valley Medical Foundation | Internal Medicine | Current |
Accepting new patients |
| Sutter Valley Medical Foundation | Current |
Accepting new patients | |
| Sutter North Medical Foundation | Past | Accepting new patients | |
| Sutter Tracy Community Hospital | Past | Accepting new patients | |
| PHC-Las Cruces Inc | Past | Accepting new patients | |
| Sutter Valley Hospitals | 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
2545 W Hammer Ln
Stockton, CA 95209
Phone (209) 948-1641
1801 E March Ln
Ste A170
Stockton, CA 95210
Phone (209) 477-5552
Interoperability endpoints
- mali549481@hisp.ehr.sutterhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 052353 | CT | |
| Hospitalist Physician | 208M00000X | 052353 | CT | |
| Interventional Cardiology Physician | 207RI0011X | A147096 | CA | Yes |
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
Other providers in Stockton, CA
- Akeel Ali
- Amani Ali
- Amina Ali
- Ashim Haydar Ali
- Ashiyana Ali
- Syed S Ali
- Syed Umer Ali
- Yousra Eman Ali
- Agnes Tagorda Alicar
- Saad K Aljoher
All providers in Stockton, CA · Interventional Cardiology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.