Individual provider Active NPI

Viktoria Graham, PA

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1669907358
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9109800 Issued in FL
Practice address
39 Barkley Cir
Fort Myers, FL 33907-7531
Phone
(239) 939-1002
Fax
(239) 495-6247
NPI assigned
May 1, 2017
Last updated
Feb 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9109800 FL Primary

Addresses

Primary practice location

39 Barkley Cir
Fort Myers, FL 33907-7531

Mailing address

39 Barkley Cir
Fort Myers, FL 33907-7531

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170921003425 FL Practitioner - Physician Assistant 0042584534 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Healthcare Specialists, LLCGroup PAC ID 6103284955, 129 clinicians
Genesiscare USA of Florida LLCGroup PAC ID 9830082882, 172 clinicians

Practice addresses (Care Compare)

12700 Creekside LN
Fort Myers, FL 33919-3356
Phone (239) 936-1616

13691 Metro Pkwy
Suite 300
Fort Myers, FL 33912-4322
Phone (239) 291-6970

15761 New Hampshire CT
Fort Myers, FL 33908-4176
Phone (239) 415-8377

21 Barkley Cir
Fort Myers, FL 33907-7531
Phone (239) 939-2616

24 Del Prado Blvd N
Cape Coral, FL 33909-2780
Phone (239) 772-2171

39 Barkley Cir
Fort Myers, FL 33907-7531
Phone (239) 936-1616

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.09 of 100Reported as individual
Quality
76.52
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genesiscare USA of Florida LLC CurrentSince Jan 4, 2021 Accepting new patients
Lehigh Pulmonary Associates, Inc PastSince Aug 15, 2021 Accepting new patients
Mark H Montgomery MD PA PastSince Nov 1, 2019 Accepting new patients

Locations

24 Del Prado Blvd N
Cape Coral, FL 33909
Phone (239) 325-1440

12700 Creekside Ln
Ste 202
Fort Myers, FL 33919
Phone (239) 489-4454

15761 New Hampshire Ct
Fort Myers, FL 33908
Phone (239) 415-8377

21 Barkley Cir
Fort Myers, FL 33907
Phone (239) 939-2616

39 Barkley Cir
Fort Myers, FL 33907
Phone (239) 936-1616

1530 Lee Blvd
Ste 2100
Lehigh Acres, FL 33936
Phone (239) 369-3333

730 Goodlette Rd
Ste 201
Naples, FL 34102
Phone (239) 262-1119

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8796/brand/1/csg/1/fhir/r4
  • Direct secure messaging: viktoriapanasiukgraham@entsf.allscriptsdirect.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 2

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": "1493596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1669907358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 BARKLEY CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339077531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 BARKLEY CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339077531",
            "telephone_number": "239-939-1002",
            "fax_number": "239-495-6247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "VIKTORIA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-01",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.