Protiva Shooprova Khan, OD is a medicare enrolled "Optometrist" provider in Mariposa, California. She graduated from medical school in 2017 and has 9 years of diverse experience with area of expertise as Optometry. She is a member of the group practice Southern California Permanente Medical Group and her current practice location is
5192 Hospital Road, Mariposa, California. You can reach out to her office (for appointments etc.) via phone at
(209) 742-6144.
Protiva Shooprova Khan is licensed to practice in California (license number 34680) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1902327240.
Healthcare Provider's Profile
| Full Name | Protiva Shooprova Khan |
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| Gender | Female |
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| Speciality | Optometry |
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| Experience | 9 Years |
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| Location | 5192 Hospital Road, Mariposa, California |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Protiva Shooprova Khan graduated from medical school in 2017
NPI Data:
- NPI Number: 1902327240
- Provider Enumeration Date: 06/27/2017
- Last Update Date: 11/01/2021
Medicare PECOS Information:
- PECOS PAC ID: 7810249968
- Enrollment ID: I20210318002480
Medical Identifiers
Medical identifiers for Protiva Shooprova Khan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1902327240 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 152W00000X | Optometrist | TUV008592-1 (New York) | Secondary |
| 152W00000X | Optometrist | 34680 (California) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Southern California Permanente Medical Group | 6002729175 | 11244 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Protiva Shooprova Khan allows following entities to bill medicare on her behalf.
| Provider Name | Dr Matthew B Lee Od Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1770122061
PECOS PAC ID: 7911333752
Enrollment ID: O20200214000327 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Protiva Shooprova Khan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Protiva Shooprova Khan, OD
2912 Willowbrook Dr Apt 3,
Merced, CA 95348-1301
Ph: (213) 820-6350 | Protiva Shooprova Khan, OD
5192 Hospital Road,
Mariposa, CA 95338
Ph: (209) 742-6144 |
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