Vivian Nia Koufogazos, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9118111 Issued in FL

Practice address

18981 N Dale Mabry Hwy
Lutz, FL 33548-4981

Phone

(813) 388-5922

NPI assigned

Nov 27, 2023

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
• Direct secure messaging: vkoufogazos342423@direct.tgh.org

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.

• Tampa General Medical Group Inc

  dba TGMG Bayshore

  • Surgery Physician
  • Tampa, FL
  • NPI 1043557853
  Medicare reassignment
• Doctors Urgent Care of Lutz LLC

  • Urgent Care Clinic/Center
  • Lutz, FL
  • NPI 1417466525
  NPD
• Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1124558929
  NPD
• Tampa General Medical Group Inc

  dba TGH Heart & Vascular Institute Sun City

  • Cardiovascular Disease Physician
  • Sun City Center, FL
  • NPI 1144910316
  NPD
• Tampa General Medical Group Inc

  dba TGH Family Care Center Healthpark

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1487991477
  NPD
• Doctors Urgent Care of Lutz LLC

  dba Urgent Care of NPR, LLC

  • Urgent Care Clinic/Center
  • New Port Richey, FL
  • NPI 1760118731
  NPD (past)
• Tampa General Medical Group Inc

  dba TGMG Lois

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1164769063
  NPD (past)

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1083480636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18981 N DALE MABRY HWY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18981 N DALE MABRY HWY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484981",
            "telephone_number": "813-388-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUFOGAZOS",
        "first_name": "VIVIAN",
        "middle_name": "NIA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9118111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meredith Knitch, LMHC
• Robert F. Koch, D.O.
• Nanda Kishor Kommineni
• Averi Laine Kosloske
• Sophia Nikolay Kosturova
• Ryan Krupnick
• Derrick Michael Kugel
• Andrew Jacob Kuntz
• Valerie Reeves Kurek, A.P.
• Sugabramya Kuru, MD

• Physician Assistant in Lutz, FL
• Providers in Lutz, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.