NPIMap

Individual provider Active NPI

Ahgnes Ungoco Bolusa-Sabugo, MD

  • Family Medicine Physician
  • Lynchburg, VA
National Provider Identifier
1386819928
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101243921 Issued in VA
Practice address
320 Federal St
Lynchburg, VA 24504-2306
Phone
(434) 947-5967
Fax
(434) 455-2487
NPI assigned
Apr 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 266535 NY
Family Medicine Physician 207Q00000X 0101243921 VA Primary

Addresses

Primary practice location

320 Federal St
Lynchburg, VA 24504-2306

Mailing address

134 Elon Rd
Madison Heights, VA 24572-2536
Phone (434) 455-2480

Other identifiers 1

IdentifierTypeStateIssuer
03495012MedicaidNY

Other names 1

  • Dr. Ahgnes Ungoco Bolusa Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20080911000650 VA Practitioner - Family Practice 7214003466 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Johnson Health CenterGroup PAC ID 9537060413, shared by 5 NPIs, 39 clinicians

Practice addresses (Care Compare)

109 Clearview Rd
Madison Heights, VA 24572-2600
Phone (434) 455-2480

134 Elon Rd
Madison Heights, VA 24572-2536

200 Amelon SQ
Madison Heights, VA 24572-5981
Phone (434) 929-1400

2402 Atherholt Rd
Lynchburg, VA 24501-2148
Phone (434) 200-6401

320 Federal St
Lynchburg, VA 24504-2306
Phone (434) 947-5967

925 Village Hwy
Rustburg, VA 24588-4591
Phone (434) 528-0005

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
266535NYMDFamily Medicine Physician
0101243921VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johnson Health Center CurrentSince Dec 5, 2018 Accepting new patients
Johnson Health Center Current Accepting new patients
Johnson Health Center CurrentSince Feb 1, 2018 Accepting new patients
Johnson Health Center CurrentSince Jul 1, 2015 Accepting new patients
Wellmont Physician Services Inc Family Medicine Past Accepting new patients

Locations

320 Federal St
Lynchburg, VA 24504
Phone (434) 947-5967

2402 Atherholt Rd
Lynchburg, VA 24501
Phone (434) 200-6401

109 Clearview Rd
Madison Heights, VA 24572
Phone (434) 929-1400

200 Amelon Sq
Madison Heights, VA 24572
Phone (434) 929-1095

134 Elon Rd
Madison Hts, VA 24572
Phone (434) 929-1400

925 Village Hwy
Rustburg, VA 24588
Phone (434) 332-7367

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1386819928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ELON RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "245722536",
            "telephone_number": "434-455-2480",
            "fax_number": "434-455-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 FEDERAL ST",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245042306",
            "telephone_number": "434-947-5967",
            "fax_number": "434-455-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLUSA-SABUGO",
        "first_name": "AHGNES",
        "middle_name": "UNGOCO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "266535",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101243921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03495012",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AHGNES",
            "last_name": "BOLUSA",
            "middle_name": "UNGOCO",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.