Individual provider Active NPI

Ivana Gagula-Latham, D.O.

  • Anesthesiology Physician
  • Largo, FL
National Provider Identifier
1063861482
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
OS16761 Issued in FL
Practice address
201 14TH St SW
Largo, FL 33770-3133
Phone
(561) 699-2954
NPI assigned
Jun 7, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X OS16761 FL Primary

Addresses

Primary practice location

201 14TH St SW
Largo, FL 33770-3133

Mailing address

201 14TH St SW
Largo, FL 33770-3133
Phone (561) 699-2954

Other practice location 1

701 6th St S
St Petersburg, FL 33701-4814
Phone (321) 841-2335

Other identifiers 1

IdentifierTypeStateIssuer
107446400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200731002084 FL Practitioner - Anesthesiology 9830514207 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Nova Southeastern College of Osteo Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

701 6TH St S
St Petersburg, FL 33701-4814
Phone (727) 893-6182

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Jan 31, 2025 Accepting new patients
Ohi West Medical Group, LLC CurrentSince Jan 13, 2025 Accepting new patients
Ohi West Medical Group, LLC CurrentSince Jan 13, 2025 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jan 31, 2025 Accepting new patients
Orlando Health, Inc. Current Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

701 6th St S
St Petersburg, FL 33701
Phone (727) 450-1144

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: igagulalatham188826@orlandohealth.medalliesdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1063861482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 14TH ST SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703133",
            "telephone_number": "561-699-2954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 14TH ST SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703133",
            "telephone_number": "561-699-2954"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 6th St S",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337014814",
            "country_code": "US",
            "telephone_number": "321-841-2335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGULA-LATHAM",
        "first_name": "IVANA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-07",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "OS16761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107446400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.