Individual provider Active NPI

Ali Syed Habib, D.O

  • Internal Medicine Physician
  • Fountain Valley, CA
National Provider Identifier
1821471442
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A16412 Issued in CA
Practice address
17360 Brookhurst St
Fountain Valley, CA 92708-3720
Phone
(714) 665-1797
NPI assigned
Jun 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20A16412 CA Primary

Addresses

Primary practice location

17360 Brookhurst St
Fountain Valley, CA 92708-3720

Mailing address

17360 Brookhurst St
Fountain Valley, CA 92708-3720
Phone (657) 241-3592

Other practice location 1

17360 Brookhurst St
Fountain Valley, CA 92708-3720
Phone (714) 665-1797

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180920003370 CA Practitioner - Internal Medicine 5698026235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

2110 N Bellflower Blvd
Long Beach, CA 90815-3126
Phone (562) 346-2222

Hospital & facility affiliations

  • Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485
  • Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678

Merit-based Incentive Payment System (MIPS)

Final score
87.17 of 100Reported as group
Quality
81.15
Promoting interoperability
100
Improvement activities
40
Cost
71.64

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16412CAMDClinical Social Worker
20A16412CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Bristol Park Medical Group, Inc Internal Medicine Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

2110 N Bellflower Blvd
Long Beach, CA 90815
Phone (562) 346-2222

2742 Dow Ave
Tustin, CA 92780
Phone (714) 665-1600

Interoperability endpoints

  • Direct secure messaging: ahabib500006@direct.memorialcare.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1821471442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720",
            "telephone_number": "657-241-3592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720",
            "telephone_number": "714-665-1797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17360 Brookhurst St",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927083720",
            "country_code": "US",
            "telephone_number": "714-665-1797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HABIB",
        "first_name": "ALI",
        "middle_name": "SYED",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-30",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A16412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.