Individual provider Active NPI

Gul Khan, PA-C

  • Physician Assistant
  • Floral Park, NY
National Provider Identifier
1962894659
Registry record updated Jan 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
026104 Issued in NY
Practice address
26701 Hillside Ave
Floral Park, NY 11004-1743
Phone
(718) 343-7790
Fax
(929) 341-3644
NPI assigned
Mar 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 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 026104 NY Primary

Addresses

Primary practice location

26701 Hillside Ave
Floral Park, NY 11004-1743

Mailing address

8268 164TH St
Jamaica, NY 11432-1104
Phone (917) 502-0054

Other identifiers 1

IdentifierTypeStateIssuer
1962894659OtherNYNPI NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20210309002419 NY Practitioner - Physician Assistant 7911313374 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians
North Shore Hematology Oncology Associates PCGroup PAC ID 1456243641, 474 clinicians

Practice addresses (Care Compare)

2640 Merrick Rd
Bellmore, NY 11710-5715
Phone (516) 537-9064

48 Route 25a
Smithtown, NY 11787-1431
Phone (631) 751-3000

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients

Locations

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: gkhan3627642@nychhc.direct-ci.com

Organizations & group practices 5

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": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1962894659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321104",
            "telephone_number": "917-502-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26701 HILLSIDE AVE",
            "city": "FLORAL PARK",
            "state": "NY",
            "postal_code": "110041743",
            "telephone_number": "718-343-7790",
            "fax_number": "929-341-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "GUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-04",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1962894659",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Floral Park, NY

Sources for this page

Verify at the official NPI Registry.