Individual provider Active NPI

Komail Mujtaba Ali, MBBS

  • Internal Medicine Physician
  • Riverside, CA
National Provider Identifier
1962039636
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A185057 Issued in CA
Practice address
10800 Magnolia Ave
Riverside, CA 92505-3043
Phone
(833) 574-2273
Fax
(833) 574-2273
NPI assigned
Mar 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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 A185057 CA Primary

Addresses

Primary practice location

10800 Magnolia Ave
Riverside, CA 92505-3043

Mailing address

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (833) 574-2273

Other practice location 1

7600 River Rd
North Bergen, NJ 07047-6217
Phone (201) 710-2756

Other practice location 2

26520 Cactus Ave Ste 201
Moreno Valley, CA 92555-3927
Phone (951) 486-5908

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20241226000945 CA Practitioner - Internal Medicine 0840727269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alertive Healthcare Medical Group ApcGroup PAC ID 9335543974, 39 clinicians

Practice addresses (Care Compare)

4354 Latham St
Suite 100
Riverside, CA 92501-1777
Phone (951) 466-6628

Hospital & facility affiliations

  • Riverside Community Hospital Hospital, Riverside, CA, CCN 050022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A185057CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alertive Healthcare Medical Group Apc Internal Medicine CurrentSince Oct 1, 2025 Accepting new patients

Locations

4354 Latham St
Ste 100
Riverside, CA 92501
Phone (909) 787-1101

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

4500 Brockton Ave
Ste 305
Riverside, CA 92501
Phone (951) 466-6628

Organizations & group practices 1

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 1

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1962039636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "833-574-2273",
            "fax_number": "833-574-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "833-574-2273",
            "fax_number": "833-574-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7600 River Rd",
            "address_purpose": "LOCATION",
            "city": "North Bergen",
            "state": "NJ",
            "postal_code": "070476217",
            "country_code": "US",
            "telephone_number": "201-710-2756",
            "fax_number": "201-758-2740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26520 Cactus Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925553927",
            "country_code": "US",
            "telephone_number": "951-486-5908",
            "fax_number": "951-486-5910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALI",
        "first_name": "KOMAIL MUJTABA",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-12-30",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A185057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.