Individual provider Active NPI

Momina Khan, PA-C

  • Physician Assistant
  • Worcester, MA
National Provider Identifier
1215743380
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
70 Gold Star Blvd
Worcester, MA 01606-2812
Phone
(508) 426-9002
Fax
(508) 426-9070
NPI assigned
Dec 4, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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 MA Primary

Addresses

Primary practice location

70 Gold Star Blvd
Worcester, MA 01606-2812

Mailing address

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

Other practice location 1

8360 Old York Rd
Elkins Park, PA 19027-1576
Phone (215) 780-1400

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
I20250509001060 MA Practitioner - Physician Assistant 0042737306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
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)

139 Turnpike Rd
Westborough, MA 01581-2835
Phone (508) 882-7300

20 Commercial Rd
Suite 2
Leominster, MA 01453-3339
Phone (978) 798-6896

245 Hartford Ave
Bellingham, MA 02019-3007
Phone (774) 295-4355

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

70 Gold Star Blvd
Worcester, MA 01606-2812
Phone (508) 426-9002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Convenientmd - FFS UC LLC CurrentSince Apr 15, 2025 Accepting new patients
Convenientmd - FFS UC LLC CurrentSince Apr 15, 2025 Accepting new patients

Locations

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

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

70 Gold Star Blvd
Worcester, MA 01606
Phone (508) 426-9002

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

Organizations & group practices 3

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": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1215743380",
    "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": "70 GOLD STAR BLVD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062812",
            "telephone_number": "508-426-9002",
            "fax_number": "508-426-9070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8360 Old York Rd",
            "address_purpose": "LOCATION",
            "city": "Elkins Park",
            "state": "PA",
            "postal_code": "190271576",
            "country_code": "US",
            "telephone_number": "215-780-1400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOMINA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-04",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.