NPIMap

Individual provider Active NPI

Michael Bougoulias, M.D.

  • Family Medicine Physician
  • Lake Mary, FL
National Provider Identifier
1174514178
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME61499 Issued in FL
Practice address
719 Rodel CV Ste 2001
Lake Mary, FL 32746-5716
Phone
(407) 302-3115
Fax
(321) 203-4602
NPI assigned
Oct 31, 2005
Last updated
May 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME61499 FL Primary

Addresses

Primary practice location

719 Rodel CV Ste 2001
Lake Mary, FL 32746-5716

Mailing address

719 Rodel CV Ste 2001
Lake Mary, FL 32746-5716
Phone (407) 302-3115

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071119000107 FL Practitioner - Family Practice 4880599679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Florida College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians
Orlando Physicians Network IncGroup PAC ID 7719026251, 231 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

21 Columbia St
Orlando, FL 32806-1133
Phone (321) 841-6600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Physicians Network Inc Family Medicine CurrentSince Apr 21, 2020 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc Past Accepting new patients

Locations

719 Rodel Cv
Ste 1015
Lake Mary, FL 32746
Phone (407) 262-5800

719 Rodel Cv
Ste 2001
Lake Mary, FL 32746
Phone (407) 302-3106

21 Columbia St
Orlando, FL 32806
Phone (321) 841-5560

Interoperability endpoints

  • Direct secure messaging: mbougoulias10051@orlandohealth.medalliesdirect.net

Organizations & group practices 3

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 10

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1174514178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 RODEL CV STE 2001",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465716",
            "telephone_number": "407-302-3115",
            "fax_number": "321-203-4602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 RODEL CV STE 2001",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465716",
            "telephone_number": "407-302-3115",
            "fax_number": "321-203-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUGOULIAS",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME61499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.