DR. KIMBERLY BOUGOULIAS M.D.
NPI 1457342453
Pediatrics in Lake Mary, FL

Q: What is Kimberly Bougoulias's NPI number?

The NPI number for Kimberly Bougoulias is 1457342453. It was assigned to this individual provider in the NPPES registry on October 31, 2005.

Q: What is Kimberly Bougoulias's specialty?

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

Active since October 31, 2005PECOS Enrolled

725 RODEL CV, LAKE MARY, FL 32746(407) 302-3130(407) 302-3132 Get Directions Write a Review

NPPES record last updated: May 18, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 18, 2020, Mar 15, 2017 (2 updates tracked since 2017).

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About Dr. Kimberly Bougoulias M.d. NPPES

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

DR. KIMBERLY BOUGOULIAS M.D. (NPI 1457342453) is an individual pediatrics provider in Lake Mary, Florida, licensed in Florida (ME61498) and active in the NPI registry since October 2005. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457342453

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameDR. KIMBERLY BOUGOULIASCredential: M.D.

Location Address725 RODEL CVLake Mary, FL 32746-4859

Mailing Address725 Rodel CvLake Mary, FL 32746-4859 · (407) 302-3130 · Fax (407) 302-3132

Phone(407) 302-3130

Fax(407) 302-3132

Sole ProprietorNo

Enumeration DateOctober 31, 2005

Last NPPES UpdateMay 18, 20202 updates tracked since enumeration

NPPES CertifiedMay 18, 2020

✔ NPI 1457342453 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in FL · ME61498

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.

725 RODEL CV, Lake Mary, FL 32746

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Other Identifiers 1

Medicaid375490100FL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kimberly Bougoulias M.d. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32746 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

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

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 19

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

ERYNNE L BOWERS MD

Pediatrics