ABDUL ANSARI
NPI 1124655170
Dermatology in Corona, CA

Q: What is Abdul Ansari's NPI number?

The NPI number for Abdul Ansari is 1124655170. It was assigned to this individual provider in the NPPES registry on March 26, 2020.

Q: What is Abdul Ansari's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Q: When was this NPI record last updated?

The NPPES record for Abdul Ansari was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 26, 2020PECOS EnrolledAccepts Medicare Assignment

21634 RETREAT PKWY, CORONA, CA 92883(951) 782-3818(951) 826-8128 Get Directions Write a Review

NPPES record last updated: September 15, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 15, 2025, Sep 2, 2025, Mar 26, 2020 (3 updates tracked since 2020).

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About Abdul Ansari NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ABDUL ANSARI (NPI 1124655170) is an individual dermatology provider in Corona, California, licensed in California (20A24148) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in Riverside, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1124655170

Entity TypeIndividualMale

Primary Taxonomy207N00000X

Provider Legal NameABDUL ANSARI

Location Address21634 RETREAT PKWYCorona, CA 92883-6100

Mailing Address3660 Arlington AveRiverside, CA 92506-3987

Phone(951) 782-3818

Fax(951) 826-8128

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateMarch 26, 2020

Last NPPES UpdateSeptember 15, 20253 updates tracked since enumeration

NPPES CertifiedSeptember 15, 2025

✔ NPI 1124655170 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in CA · 20A24148

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

21634 RETREAT PKWY, Corona, CA 92883

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Secondary Practice Location 1

Location 17160 Brockton AveRiverside, CA 92506-2620 · Phone (951) 782-3837 · Fax (951) 328-9758

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Abdul Ansari is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID749607984

PECOS Enrollment IDI20250920000001

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Abdul Ansari reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Riverside Medical Clinic, Inc

12 mi

Internal Medicine

7117 BROCKTON AVE
Riverside, CA 92506

Reassigned Medicare billing, California enrollment
349 clinicians in this Medicare group

NPI 1730180415 (951) 683-6370

Tri-State Community Healthcare Center

54 mi

Federally Qualified Health Center (FQHC)

11499 BARTLETT AVE
Adelanto, CA 92301

Reassigned Medicare billing, California enrollment
73 clinicians in this Medicare group

NPI 1508379017 (760) 444-4258

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92883 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$91.88 typical visit price

range $59.60 – $179.42

Typical copayment $22.97 (range $14.90 – $44.85)

Most-billed visit code 99203

Established Patient

$74.08 typical visit price

range $19.37 – $146.42

Typical copayment $18.52 (range $4.84 – $36.60)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RIVERSIDE MEDICAL CLINIC, INC

Family Medicine