Dr Ali Mohammed Waliul Islam, DO is a medicare enrolled "Family Medicine" physician in Port Chester, New York. His current practice location is
5 Grace Church St, Port Chester, New York. You can reach out to his office (for appointments etc.) via phone at
(914) 937-8899.
Dr Ali Mohammed Waliul Islam is licensed to practice in New York (license number 253012) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1235369463.
Physician's Profile
| Full Name | Dr Ali Mohammed Waliul Islam |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 5 Grace Church St, Port Chester, New York |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1235369463
- Provider Enumeration Date: 07/22/2009
- Last Update Date: 10/23/2018
Medicare PECOS Information:
- PECOS PAC ID: 2567716046
- Enrollment ID: I20181120000942
Medical Identifiers
Medical identifiers for Dr Ali Mohammed Waliul Islam such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1235369463 | NPI | - | NPPES |
| 03147037 | Medicaid | NY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 253012 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Ali Mohammed Waliul Islam allows following entities to bill medicare on his behalf.
| Entity Name | Damian Family Care Centers Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1508955592
PECOS PAC ID: 6507849882
Enrollment ID: O20151015001737 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ali Mohammed Waliul Islam is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Ali Mohammed Waliul Islam, DO
2604 3rd Ave,
Bronx, NY 10454-1199
Ph: (718) 292-0100 | Dr Ali Mohammed Waliul Islam, DO
5 Grace Church St,
Port Chester, NY 10573-4911
Ph: (914) 937-8899 |
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