Mahnaz Jeelani Ali, D.O.
Individual provider Active NPI Family Medicine Physician · Melrose Park, IL
NPI 1376734202 · NPPES record last updated Dec 30, 2019
Key facts
- NPI
- 1376734202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036.123445 (IL)
- Practice address
- 1111 Superior St
Suite 207
Melrose Park, IL 60160-4138 - Phone
- (708) 406-3040
- Fax
- (708) 406-3053
- NPI assigned
- Aug 6, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Midwestern University, Chicago College of Osteopathic Med, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- PCC Community Wellness Center
Practice addresses (Care Compare)
1111 Superior St
Suite 101
Melrose Park, IL 60160-4100
Phone (708) 406-3040
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- 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 |
|---|---|---|---|---|
| I20100204000723 | IL | Practitioner - Family Practice | 1850434481 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1108 | AZ | MD | Family Medicine Physician |
| 036.123445 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PCC Community Wellness Center | Current |
Accepting new patients | |
| PCC Community Wellness Center | Current |
Accepting new patients | |
| PCC Community Wellness Center | Past | Accepting new patients |
Locations
1111 Superior St
Ste 101
Melrose Park, IL 60160
Phone (708) 344-2161
1111 Superior St
Ste 207
Melrose Park, IL 60160
Phone (708) 406-3040
14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113
Interoperability endpoints
- mahnaz.ali.1@13158.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R1108 | AZ | |
| Family Medicine Physician | 207Q00000X | 036.123445 | IL | Yes |
Addresses
Primary practice location
1111 Superior St
Suite 207
Melrose Park, IL 60160-4138
Mailing address
1111 Superior St
Suite 207
Melrose Park, IL 60160-4138
Phone (708) 406-3040
Other providers in Melrose Park, IL
- Zainab Alabd
- Carlos J Alberttis
- Christina Alex
- Alexandre Family Health Center LTD
- Michelle J Alexandre
- All Kids Dental Center, LLC
- Claude Allen
- Jillian Allibone
- Nicole Marie Alvarez
- Holly Ambruso
All providers in Melrose Park, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2019. 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.