1. Home
  2. Directory
  3. Illinois
  4. Chicago
  5. Dentist
  6. NPI Profile

MUSTAFA SIDDIQ ALI DMD
NPI 1134859630
Dentist in Chicago, IL

Active since June 16, 2022PECOS Enrolled
4630 S BISHOP ST, CHICAGO, IL 60609(773) 523-2615 Get Directions Write a Review

NPPES record last updated: June 16, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mustafa Siddiq Ali Dmd NPPES

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

MUSTAFA SIDDIQ ALI DMD (NPI 1134859630) is an individual dentist in Chicago, Illinois, licensed in Illinois (019.033703) and active in the NPI registry since June 2022. He is enrolled in Medicare PECOS and is a graduate of Univ Of Illinois At Chicago College Of Dentistry (2022).

NPPES Registry Identity

NPI1134859630
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameMUSTAFA SIDDIQ ALICredential: DMD
Location Address4630 S BISHOP STChicago, IL 60609-3240
Mailing Address4630 S Bishop StChicago, IL 60609-3240 · (773) 523-2615
Phone(773) 523-2615
Sole ProprietorNo
Medical School CMSUniv Of Illinois At Chicago College Of DentistryGraduated 2022
Enumeration DateJune 16, 2022
NPPES CertifiedJune 11, 2022
✔ NPI 1134859630 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019.033703
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
4630 S BISHOP ST, Chicago, IL 60609
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Guardian.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mustafa Siddiq Ali Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4587047667
PECOS Enrollment IDI20260326001483
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

2

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

The Board Of Trustees Of The University Of Illinois
3.9 mi
Federally Qualified Health Center (FQHC)
1220 S. WOOD STREET, UIH-MILE SQUARE HEALTH CENTER
Chicago, IL 60608
  • Reassigned Medicare billing, Illinois enrollment
  • 113 clinicians in this Medicare group
NPI 1669493466 (312) 413-1261
State Of Wisconsin
65 mi
Intermediate Care Facility, Intellectual Disabilities
21425 SPRING ST
Union Grove, WI 53182
  • Reassigned Medicare billing, Wisconsin enrollment
  • 19 clinicians in this Medicare group
NPI 1043326747 (262) 878-2411

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 60609 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
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
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 6

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

TIMOTHY JAMES PETERSON MD
Family Medicine
4630 S BISHOP ST
CHICAGO, IL 60609
Cook County (312) 996-2000
BOARD OF TRUSTEES FO THE UNIVERSITY OF ILLINOIS
Case Management
4630 S BISHOP ST
CHICAGO, IL 60609
Cook County (773) 579-9401
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Health Educator
4630 S BISHOP ST
CHICAGO, IL 60609
Cook County (312) 996-2000
MARIA ALLEMANA
Social Worker (Clinical)
4630 S BISHOP ST
CHICAGO, IL 60609
Cook County (312) 996-2000
STEPHANIE NICOLE TILLMAN CNM
Advanced Practice Midwife
4630 S BISHOP ST
CHICAGO, IL 60609
Cook County (312) 996-2000
CRYSTAL MACIEL MD
Family Medicine
4630 S BISHOP ST
CHICAGO, IL 60609
Cook County (312) 996-2000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mustafa Ali's NPI number?

The NPI number for Mustafa Ali is 1134859630. It was assigned to this individual provider in the NPPES registry on June 16, 2022.

Where is Mustafa Ali located?

Mustafa Ali practices at 4630 S Bishop St, Chicago, IL 60609. The listed phone number is (773) 523-2615.

What is Mustafa Ali's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Mustafa Ali enrolled in Medicare?

Yes. Mustafa Ali is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Mustafa Ali's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mustafa Ali reassigns Medicare benefits to 2 organizations: The Board Of Trustees Of The University Of Illinois (Chicago, IL) and State Of Wisconsin (Union Grove, WI). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mustafa Ali's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mustafa Ali accept?

Health plans from Guardian list Mustafa Ali as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mustafa Ali was last updated on June 16, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.