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TAREQ A ALI MD APC
NPI 1588919716
Family Medicine in Lodi, CA

Active since July 13, 2012CLIA 05D0992255 · Waiver
1520 W KETTLEMAN LN STE B, LODI, CA 95242(209) 339-3797(209) 339-3795 Get Directions Write a Review

NPPES record last updated: July 13, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Tareq A Ali Md Apc NPPES

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

TAREQ A ALI MD APC (NPI 1588919716) is a healthcare organization registered as a family medicine in Lodi, California and active in the NPI registry since July 2012. The organization holds a CLIA Waiver certificate valid through June 20, 2028 and lists Tareq A Ali, President Of Corporation, as its authorized official.

NPPES Registry Identity

NPI1588919716
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTAREQ A ALI MD APC
Location Address1520 W KETTLEMAN LN STE BLodi, CA 95242-9290
Mailing Address1520 W Kettleman Ln Ste BLodi, CA 95242-9290 · (209) 339-3797 · Fax (209) 339-3795
Phone(209) 339-3797
Fax(209) 339-3795
Organization SubpartNo
Authorized OfficialTareq A AliPresident Of Corporation · 20933393797
Enumeration DateJuly 13, 2012
✔ NPI 1588919716 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · A51048
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1520 W KETTLEMAN LN STE B, Lodi, CA 95242
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Other Identifiers 2

Medicare PIN00A510480CA
Medicare UPINF49243CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tareq A Ali Md Apc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Tareq A Ali MD Apc, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Ryan Vaccarezza, NP
Nurse Practitioner
NPI 1982037040
975 S FAIRMONT AVE
Lodi, CA 95240
(209) 334-3411
✔ PECOS✔ Accepts Medicare0.5 mi
Tareq Ali, M.D.
Emergency Medicine
NPI 1790722718
1520 W KETTLEMAN LN SUITE B
Lodi, CA 95242
(209) 339-3797
✔ PECOS✔ Accepts Medicare2.3 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0992255

Tareq A Ali MD · Lodi, CA
Active · expires Jun 20, 2028
CLIA Number05D0992255
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2026
Certificate Expiration DateJune 20, 2028
Laboratory DirectorTareq A. Ali MD
Laboratory Phone(209) 339-3797
Laboratory LocationTareq A Ali MD1520 W Kettleman Ln Ste B Tareq Ali MD Family Practice, Lodi, CA 95240
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Tareq A Ali MD Apc's NPI number?

The NPI number for Tareq A Ali MD Apc is 1588919716. It was assigned to this organization in the NPPES registry on July 13, 2012.

Where is Tareq A Ali MD Apc located?

Tareq A Ali MD Apc is located at 1520 W Kettleman Ln Ste B, Lodi, CA 95242. The listed phone number is (209) 339-3797.

What is Tareq A Ali MD Apc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Tareq A Ali MD Apc enrolled in Medicare?

Yes. Tareq A Ali MD Apc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tareq A Ali MD Apc?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Tareq A Ali MD Apc, in Emergency Medicine and Nurse Practitioner. A 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 the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Tareq A Ali MD Apc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0992255) is associated with this NPI, valid through June 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tareq A Ali MD Apc was last updated on July 13, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.