Individual provider Active NPI

Olutobi Teleekundayo

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1497230205
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1000 South Ave
Rochester, NY 14620-2733
Phone
(585) 341-6332
NPI assigned
Sep 27, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 22658 NY
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1000 South Ave
Rochester, NY 14620-2733

Mailing address

1000 South Ave
Rochester, NY 14620-2733

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address oteleekundayo117546@direct.urmc.rochester.edu Direct
Direct Messaging Address oteleekundayo117546@direct.urmc.rochester.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181126001703 NY Practitioner - Physician Assistant 1759635089 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
22658NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Hospital of Rochester CurrentSince Oct 13, 2022 Accepting new patients
Highland Hospital of Rochester CurrentSince Oct 13, 2022 Accepting new patients

Locations

1000 South Ave
#58
Rochester, NY 14620
Phone (585) 341-6776

1000 South Ave
Rochester, NY 14620
Phone (585) 341-0366

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1497230205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 SOUTH AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 SOUTH AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202733",
            "telephone_number": "585-341-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELEEKUNDAYO",
        "first_name": "OLUTOBI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-27",
        "last_updated": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "22658",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oteleekundayo117546@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oteleekundayo117546@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.