Individual provider Active NPI

Lazau P Fougere, MD

  • Family Medicine Physician
  • Temple Terrace, FL
National Provider Identifier
1699088104
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME122282 Issued in FL
Practice address
5503 E Busch Blvd
Temple Terrace, FL 33617-5419
Phone
(813) 200-7717
Fax
(813) 985-8500
NPI assigned
Jul 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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 ME122282 FL Primary

Addresses

Primary practice location

5503 E Busch Blvd
Temple Terrace, FL 33617-5419

Mailing address

507 W Alexander St
Plant City, FL 33563-7136
Phone (813) 754-3504

Other names 1

  • Lazau P Fougere Professional name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150914001725 FL Practitioner - Family Practice 1355536939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmed Medical Management of Florida IncGroup PAC ID 3971678558, 158 clinicians

Practice addresses (Care Compare)

15320 Amberly Dr
Tampa, FL 33647-1647
Phone (813) 977-2090

2940 S US Hwy 1
Suite C11 Wellmed at Fort Pierce
Fort Pierce, FL 34982-8143
Phone (772) 466-6855

Hospital & facility affiliations

  • Adventhealth Home Health Home health agency, Temple Terrace, FL, CCN 107414
  • Adventhealth Wesley Chapel Hospital, Wesley Chapel, FL, CCN 100319
  • Adventhealth Tampa Hospital, Tampa, FL, CCN 100173

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME122282FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Management of Florida Inc Family Medicine CurrentSince Jul 1, 2018 Accepting new patients

Locations

2940 S US Highway 1
Ste C11
Fort Pierce, FL 34982
Phone (407) 423-5178

507 W Alexander St
Plant City, FL 33563
Phone (813) 754-3504

15320 Amberly Dr
Ste A
Tampa, FL 33647
Phone (813) 977-0733

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: lazau.fougere@wellmed.eclinicaldirectplus.com

Organizations & group practices 1

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 4

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": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529625600000",
    "number": "1699088104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 W ALEXANDER ST",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335637136",
            "telephone_number": "813-754-3504",
            "fax_number": "813-752-6863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5503 E BUSCH BLVD",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336175419",
            "telephone_number": "813-200-7717",
            "fax_number": "813-985-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUGERE",
        "first_name": "LAZAU",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-26",
        "last_updated": "2018-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME122282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAZAU",
            "last_name": "FOUGERE",
            "middle_name": "P",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Temple Terrace, FL

Sources for this page

Verify at the official NPI Registry.