Agatha Matsos Formoso, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

24172 Issued in NV

Practice address

2650 N Tenaya Way # 308
Las Vegas, NV 89128-1102

Phone

(702) 870-2099

Fax

(702) 869-5347

NPI assigned

Apr 2, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agathaformoso@hcpnv.allscriptsdirect.net

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.

• Intermountain Medical Holdings Nevada Inc

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279

  Pediatrics

  Medicare reassignment NPD
• Intermountain Medical Holdings Nevada Inc

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557
  NPD
• Centennial Hills Hospital Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1487771812
  NPD (past)
• Sunrise Mountainview Hospital, Inc.

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1104870187
  NPD (past)

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1124657036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 N TENAYA WAY # 308",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281102",
            "telephone_number": "702-870-2099",
            "fax_number": "702-869-5347"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 E Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850167710",
            "country_code": "US",
            "telephone_number": "602-933-0945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORMOSO",
        "first_name": "AGATHA",
        "middle_name": "MATSOS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-02",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "24172",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Henry Forkos II, MD
• Forma Integrated Healthcare
• Arjinae Forman
• Kerri Shea Forman, CST, A.S.
• Abby Formica
• Miriam Formoso
• Ciana Fornaris
• Jasmina Santos Fornbacher, APRN
• Roy Forner
• Jessica Fornes, RN

• Pediatrics Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pediatrics Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.