NPIMap

Individual provider Active NPI

Mahmoud Ali

  • Clinical Cardiac Electrophysiology Physician
  • Libertyville, IL
National Provider Identifier
1366837635
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
036-167077 Issued in IL
Practice address
900 Technology Way Ste 220
Libertyville, IL 60048-5364
Phone
(847) 367-7171
Fax
(847) 367-7177
NPI assigned
Apr 2, 2015
Last updated
Feb 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X 69397-20 WI
Clinical Cardiac Electrophysiology Physician 207RC0001X 036-167077 IL Primary

Addresses

Primary practice location

900 Technology Way Ste 220
Libertyville, IL 60048-5364

Mailing address

29373 Network PL
Chicago, IL 60673-5506
Phone (847) 390-5900

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mali199922@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190626003140 WI Practitioner - Cardiac ElectrophysiologyPractitioner - Internal Medicine 5698077410 Reassigns benefits to 4 organizations
I20240104001377 IL Practitioner - Cardiac Electrophysiology 5698077410

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

14555 W National Ave
Suite 160
New Berlin, WI 53151-4497
Phone (262) 827-2975

6901 W Edgerton Ave
Milwaukee, WI 53220-4420
Phone (414) 421-8400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-167077ILMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Jul 7, 2019 Accepting new patients
Lakeshore Medical Clinic LTD CurrentSince Jul 7, 2019 Accepting new patients
Aurora Advanced Healthcare, Inc. Internal Medicine CurrentSince Jul 7, 2019 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jul 7, 2019 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Jul 7, 2019 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jul 7, 2019 Accepting new patients
Beloit Health System, Inc CurrentSince Sep 15, 2024 Accepting new patients
Beloit Health System Inc Internal Medicine Current Accepting new patients
Beloit Health System, Inc Internal Medicine CurrentSince Sep 15, 2024 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Beloit Health System Inc Past Accepting new patients

Locations

1735 Madison Rd
Beloit, WI 53511
Phone (608) 363-7510

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

1969 W Hart Rd
Beloit, WI 53511
Phone (608) 364-5011

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

10400 75th St
Ste 212
Kenosha, WI 53142

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

6901 W Edgerton Ave
Milwaukee, WI 53220
Phone (414) 325-5244

945 N 12th St
Milwaukee, WI 53233
Phone (414) 219-5800

13250 Washington Ave
Fl 2
Mount Pleasant, WI 53177

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

14555 W National Ave
Ste 160
New Berlin, WI 53151
Phone (262) 827-2975

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: mali199922@direct.myadvocateaurora.org

Organizations & group practices 11

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": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1366837635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735506",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 TECHNOLOGY WAY STE 220",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485364",
            "telephone_number": "847-367-7171",
            "fax_number": "847-367-7177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALI",
        "first_name": "MAHMOUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "WI",
            "license": "69397-20",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IL",
            "license": "036-167077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mali199922@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "900 Technology Way Ste 220",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600485364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "900 Technology Way Ste 220",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600485364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.