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FORMA INTEGRATED HEALTHCARE
NPI 1023964657
Specialist in Las Vegas, NV

Active since March 06, 2026
2655 S RAINBOW BLVD STE 410, LAS VEGAS, NV 89146(702) 726-9722(702) 906-0067 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Forma Integrated Healthcare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FORMA INTEGRATED HEALTHCARE (NPI 1023964657) is a healthcare organization registered as a specialist in Las Vegas, Nevada and active in the NPI registry since March 2026. The organization lists Ann Uganiza, Ceo, as its authorized official.

NPPES Registry Identity

NPI1023964657
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameFORMA INTEGRATED HEALTHCARE
Location Address2655 S RAINBOW BLVD STE 410Las Vegas, NV 89146-5100
Mailing Address2655 S Rainbow Blvd Ste 410Las Vegas, NV 89146-5100 · (702) 726-9722 · Fax (702) 906-0067
Phone(702) 726-9722
Fax(702) 906-0067
Organization SubpartNo
Authorized OfficialAnn UganizaCeo · (702) 531-4540
Enumeration DateMarch 6, 2026
Last NPPES UpdateMarch 9, 2026
NPPES CertifiedMarch 9, 2026
✔ NPI 1023964657 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Also ListedPsychologist · FamilyTaxonomy 103TF0000X
Also ListedRegistered Nurse · Wound CareTaxonomy 163WW0000X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X
2655 S RAINBOW BLVD STE 410, Las Vegas, NV 89146
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Forma Integrated Healthcare is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Forma Integrated Healthcare, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Goldyn Dimasin, APRN
Nurse Practitioner
NPI 1013624501
3900 W CHARLESTON BLVD STE 170
Las Vegas, NV 89102
(702) 362-2273
✔ PECOS✔ Accepts Medicare3.2 mi
Kevin Zhagui, APRN
Nurse Practitioner
NPI 1447055173
5536 S FORT APACHE RD STE 102
Las Vegas, NV 89148
(702) 915-7001
✔ PECOS✔ Accepts Medicare4.6 mi
Heyaw Amene
Nurse Practitioner
NPI 1447997325
9333 W SUNSET RD STE A
Las Vegas, NV 89148
(725) 745-5864
✔ PECOS✔ Accepts Medicare5.8 mi
John Valles, M.D.
Psychiatry
NPI 1972545994
2255 RENAISSANCE DR STE B
Las Vegas, NV 89119
(702) 500-1728
✔ PECOS✔ Accepts Medicare7.4 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Forma Integrated Healthcare's NPI number?

The NPI number for Forma Integrated Healthcare is 1023964657. It was assigned to this organization in the NPPES registry on March 6, 2026.

Where is Forma Integrated Healthcare located?

Forma Integrated Healthcare is located at 2655 S Rainbow Blvd Ste 410, Las Vegas, NV 89146. The listed phone number is (702) 726-9722.

What is Forma Integrated Healthcare's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Forma Integrated Healthcare enrolled in Medicare?

Yes. Forma Integrated Healthcare is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Forma Integrated Healthcare?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Forma Integrated Healthcare. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (3) and Psychiatry (1). Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Forma Integrated Healthcare was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.