Syed Masood Ali, MDSC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

036067626 Issued in IL

Legal business name

SYED MASOOD ALI, MDSC

Doing business as

Glen Avenue Family Practice

Practice address

4930 N Executive Dr
Peoria, IL 61614-4894

Phone

(309) 692-7575

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Susan Lafollette

Title

Billing Manager

Phone

(309) 671-8749

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Glen Avenue Family Practice Doing business as

Practitioners 1

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

• Maqbool B Ali, M.D

  • Surgery Physician
  • Peoria, IL
  • NPI 1801874565
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1689896961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 N EXECUTIVE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144894",
            "telephone_number": "309-692-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 N EXECUTIVE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144894",
            "telephone_number": "309-692-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYED MASOOD ALI, MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "LAFOLLETTE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "309-671-8749"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "036067626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "212719",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Avenue Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven Swiryn, M.D.
• James L Swischuk, MD
• Lindsey Swischuk, APN
• Holly Swisher, APN
• Sara Sychra, APN,CNP
• Anwaruddin K Syed, MD
• Mukhtar Ali Syed, MD
• Taha Irfan Syed, D.O
• Synergy Center for Integrative Health PC
• James G. Szudera, D.O.

• General Practice Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.