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DR. AGATHA MATSOS FORMOSO MD
NPI 1124657036
Pediatrics in Las Vegas, NV

Active since April 02, 2020PECOS Enrolled
2650 N TENAYA WAY # 308, LAS VEGAS, NV 89128(702) 870-2099(702) 869-5347 Get Directions Write a Review

NPPES record last updated: November 16, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 16, 2023, Apr 2, 2020 (2 updates tracked since 2020).

About Dr. Agatha Matsos Formoso Md NPPES

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

DR. AGATHA MATSOS FORMOSO MD (NPI 1124657036) is an individual pediatrics provider in Las Vegas, Nevada, licensed in Nevada (24172) and active in the NPI registry since April 2020. She is enrolled in Medicare PECOS and maintains a secondary practice location in Phoenix.

NPPES Registry Identity

NPI1124657036
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameDR. AGATHA MATSOS FORMOSOCredential: MD
Location Address2650 N TENAYA WAY # 308Las Vegas, NV 89128-1102
Mailing Address6355 S Buffalo Dr Fl 3Las Vegas, NV 89113-2133 · (702) 216-3346
Phone(702) 870-2099
Fax(702) 869-5347
Sole ProprietorNo
Enumeration DateApril 2, 2020
Last NPPES UpdateNovember 16, 20232 updates tracked since enumeration
NPPES CertifiedNovember 16, 2023
✔ NPI 1124657036 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in NV · 24172
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
2650 N TENAYA WAY # 308, Las Vegas, NV 89128
Open in Google Maps ↗

Secondary Practice Location 1

Location 11919 E Thomas RdPhoenix, AZ 85016-7710 · Phone (602) 933-0945

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Agatha Matsos Formoso Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Agatha Formoso reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Intermountain Medical Holdings Nevada Inc
18 mi
Internal Medicine
595 W LAKE MEAD PKWY
Henderson, NV 89015
  • Reassigned Medicare billing, Nevada enrollment
  • 521 clinicians in this Medicare group
NPI 1245997279 (702) 566-5500

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 89128 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.51 typical visit price
range $57.07 – $173.24
Typical copayment $22.12 (range $14.26 – $43.31)
Most-billed visit code 99203
Established Patient
$100.60 typical visit price
range $18.27 – $140.96
Typical copayment $25.15 (range $4.56 – $35.24)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID RAFFERTY
Pediatrics
2650 N TENAYA WAY # 308
LAS VEGAS, NV 89128
Clark County (702) 870-2099

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 Agatha Formoso's NPI number?

The NPI number for Agatha Formoso is 1124657036. It was assigned to this individual provider in the NPPES registry on April 2, 2020.

Where is Agatha Formoso located?

Agatha Formoso practices at 2650 N Tenaya Way # 308, Las Vegas, NV 89128. The listed phone number is (702) 870-2099.

What is Agatha Formoso's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Agatha Formoso enrolled in Medicare?

Yes. Agatha Formoso is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Agatha Formoso's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Agatha Formoso reassigns Medicare benefits to Intermountain Medical Holdings Nevada Inc (Henderson, NV). The 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 Agatha Formoso'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 Agatha Formoso was last updated on November 16, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.