NICOLE KOULISIS MD
NPI 1073033213
Ophthalmology - Retina Specialist in Encino, CA
About Nicole Koulisis Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NICOLE KOULISIS MD (NPI 1073033213) is an individual retina specialist in Encino, California, licensed in California (A157849) and active in the NPI registry since June 2017. She is enrolled in Medicare PECOS, maintains a secondary practice location in Los Angeles, and is a graduate of Other (2017).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Nicole Koulisis Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Nicole Koulisis reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Encino, CA 91316
- Reassigned Medicare billing, California enrollment
- 2 clinicians in this Medicare group
Los Angeles, CA 90033
- Reassigned Medicare billing, California enrollment
- 2,445 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 11
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91316 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ENCINO, CA 91316
ENCINO, CA 91316
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 Nicole Koulisis's NPI number?
The NPI number for Nicole Koulisis is 1073033213. It was assigned to this individual provider in the NPPES registry on June 20, 2017.
Where is Nicole Koulisis located?
Nicole Koulisis practices at 5400 Balboa Blvd Ste 126, Encino, CA 91316. The listed phone number is (818) 578-0004.
What is Nicole Koulisis's specialty?
The primary specialty registered for this NPI is Ophthalmology, specializing in Retina Specialist, with taxonomy code 207WX0107X.
Is Nicole Koulisis enrolled in Medicare?
Yes. Nicole Koulisis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Nicole Koulisis's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Nicole Koulisis reassigns Medicare benefits to 2 organizations: Retina Los Angeles (Encino, CA) and Usc Care Medical Group, Inc (Los Angeles, CA). Each 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 Nicole Koulisis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Nicole Koulisis was last updated on December 1, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# Nicole Koulisis, MD · NPI 1073033213
Retina Specialist physician in Encino, California. Individual provider, active in the CMS NPPES registry since June 20, 2017.
## Identity
- **NPI:** 1073033213 (Entity type: Individual)
- **Enumerated:** June 20, 2017
- **Primary specialty:** Ophthalmology - Retina Specialist · taxonomy 207WX0107X
- **State license:** A157849 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 5400 BALBOA BLVD STE 126, Encino, CA 91316-5202
- **Phone:** (818) 578-0004 · **Fax:** (818) 578-0002
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Retina Los Angeles (NPI 1134845837, Encino, CA); Usc Care Medical Group, Inc (NPI 1902846306, Los Angeles, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2017
## Record status
- **NPPES last updated:** December 1, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1073033213) · Data from the CMS NPPES public registry.