Organization Active NPI

Mohamed S Ali MD Professional Corporation

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1407981731
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A67534 Issued in CA
Legal business name
MOHAMED S ALI MD PROFESSIONAL CORPORATION
Practice address
10165 Foothill Blvd
#26
Rancho Cucamonga, CA 91730-0340
Phone
(909) 481-0800
Fax
(909) 481-0700
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Authorized official

Name
Mohamed S Ali, MDNPI 1548395239
Title
President
Phone
(909) 732-2732

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X A67534 CA Primary

Addresses

Primary practice location

10165 Foothill Blvd
#26
Rancho Cucamonga, CA 91730-0340

Mailing address

10165 Foothill Blvd
#26
Rancho Cucamonga, CA 91730-0340
Phone (909) 481-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070414000111 CA Part B Supplier - Clinic/Group Practice 4587769856 Receives reassigned benefits from 1 practitioner
Practice locations: Rancho Cucamonga, CA

National Provider Directory

National Provider Directory

Locations

9625 Monte Vista Ave
Ste 103
Montclair, CA 91763
Phone (909) 625-1955

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1407981731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10165 FOOTHILL BLVD",
            "address_2": "#26",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300340",
            "telephone_number": "909-481-0800",
            "fax_number": "909-481-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10165 FOOTHILL BLVD",
            "address_2": "#26",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300340",
            "telephone_number": "909-481-0800",
            "fax_number": "909-481-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAMED S ALI MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-732-2732",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A67534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.