Amena Masood Ali, BS, PA-C
Individual provider Active NPI Medical Physician Assistant · Lake Forest, CA
NPI 1609053487 · NPPES record last updated Dec 10, 2014
Key facts
- NPI
- 1609053487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA 19554 (CA)
- Practice address
- 23672 Birtcher Dr
Unit a
Lake Forest, CA 92630-1711 - Phone
- (949) 770-7301
- Fax
- (949) 770-0634
- NPI assigned
- Jan 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081028000041 | CA | Practitioner - Physician Assistant | 3870651318 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 19554 | CA | MD | Medical Physician Assistant |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA 19554 | CA | Yes |
Addresses
Primary practice location
23672 Birtcher Dr
Unit a
Lake Forest, CA 92630-1711
Mailing address
23672 Birtcher Dr
Unit a
Lake Forest, CA 92630-1711
Phone (949) 770-7301
Other providers in Lake Forest, CA
- Caitlynn Albiar
- Clare Albright
- Cheryl Evelyn Alderson
- Esther Alexander
- Mihal Alexandrov
- Mohammed Mahmood Ali
- Align Home Health Physical Therapy Inc
- All Care Medical Equipment and Supplies, LLC
- Jennifer Allanach
- Alternative Medicine & Natural Therapy Institute, a Professional Corp.
All providers in Lake Forest, CA · Medical Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2014. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.