Individual provider Active NPI

Corinne Nowak, PA-C

  • Physician Assistant
  • Bellingham, MA
National Provider Identifier
1073963500
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5738 Issued in MA
Practice address
245 Hartford Ave Ste 1
Bellingham, MA 02019-3007
Phone
(774) 295-4355
Fax
(774) 295-4880
NPI assigned
Jun 15, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5738 MA Primary

Addresses

Primary practice location

245 Hartford Ave Ste 1
Bellingham, MA 02019-3007

Mailing address

360 US Highway 1 Byp Unit 102
Portsmouth, NH 03801-7105
Phone (603) 410-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160805001418 MA Practitioner - Physician Assistant 9638463136 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Convenientmd - FFS UC LLCGroup PAC ID 5193186492, 397 clinicians

Practice addresses (Care Compare)

1285 Belmont St
Suite 1
Brockton, MA 02301-4440
Phone (508) 894-7015

40 Davis Straits
Falmouth, MA 02540-3906
Phone (774) 255-3010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5738MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Convenientmd - FFS UC LLC CurrentSince Oct 7, 2023 Accepting new patients
Brockton Hospital, Inc. CurrentSince Jun 20, 2016 Accepting new patients
Convenientmd - FFS UC LLC CurrentSince Oct 7, 2023 Accepting new patients
Brockton Hospital, Inc. CurrentSince Jun 20, 2016 Accepting new patients
Convenientmd - FFS UC LLC Past Accepting new patients
Convenientmd LLC Past Accepting new patients

Locations

245 Hartford Ave
Ste 1
Bellingham, MA 02019
Phone (774) 295-4355

245 Hartford Ave
Bellingham, MA 02019
Phone (774) 295-4355

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

40 Davis Straits
Falmouth, MA 02540
Phone (774) 255-3010

111 New Hampshire Ave
Portsmouth, NH 03801

360 US Highway 1 Byp
Unit 102
Portsmouth, NH 03801
Phone (603) 410-6700

Organizations & group practices 8

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1073963500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 US HIGHWAY 1 BYP UNIT 102",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017105",
            "telephone_number": "603-410-6700",
            "fax_number": "603-319-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 HARTFORD AVE STE 1",
            "city": "BELLINGHAM",
            "state": "MA",
            "postal_code": "020193007",
            "telephone_number": "774-295-4355",
            "fax_number": "774-295-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOWAK",
        "first_name": "CORINNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-15",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "5738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, MA

Sources for this page

Verify at the official NPI Registry.