SHAZA BEN KHADRA (MD) – Anatomic Pathology & Clinical Pathology Physician, NPI 1477176444
Anatomic Pathology & Clinical Pathology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
799 PATHOLOGY in MA
Provider Addresses for SHAZA BEN KHADRA (MD)
280 CHESTNUT STREET
2ND FLOOR
SPRINGFIELD, MA 011991001
Phone: (413) 794-3909
Fax: (413) 794-1629
Type: Mailing
759 CHESTNUT STREET
D1170
SPRINGFIELD, MA 011071619
Phone: (413) 794-4550
Fax: (413) 794-3195
Type: Location
593 Eddy St
Providence, RI 029034923
Phone: (401) 444-5057
Fax: (401) 606-1233
Type: Location
593 EDDY ST
PROVIDENCE, RI 029034923
Phone: (401) 444-5057
Fax: (401) 606-1233
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241127000511 | I | Pathology | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 01199)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MA | |
| Dermatology, Micrographic Dermatologic Surgery (Mds) | MA | |
| Physician Assistant | MA | |
| - | NY | |
| Physician Assistant | MA | |
| D E R M A T O L O G Y | MA | |
| Physician Assistant | MA | |
| Physician Assistant | MA | |
| P A T H O L O G Y | MA | |
| D E R M A T O L O G Y | MA |
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