Individual provider Active NPI

Ayodele C Ippolito

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1639897788
Registry record updated Jul 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
029370 Issued in NY
Practice address
2613 W Henrietta Rd Ste B
Rochester, NY 14623-2327
Phone
(585) 279-4999
Fax
(585) 473-5152
NPI assigned
Aug 16, 2022
Last updated
Jul 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 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 029370 NY Primary
Medical Physician Assistant 363AM0700X 29370 NY

Addresses

Primary practice location

2613 W Henrietta Rd Ste B
Rochester, NY 14623-2327

Mailing address

300 Crittenden Blvd Box Psych
Rochester, NY 14642-0001
Phone (585) 276-8375

Other names 1

  • Ayodele C Ifafore Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mlawler138983@direct.urmc.rochester.edu Direct
Direct Messaging Address mlawler138983@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
I20221215001941 NY Practitioner - Physician Assistant 3476922345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of RochesterGroup PAC ID 5799699088, 960 clinicians

Practice addresses (Care Compare)

2613 W Henrietta Rd
Rochester, NY 14623-2327
Phone (585) 279-4900

2617 W Henrietta Rd
Rochester, NY 14623-2327
Phone (585) 276-7620

601 Elmwood Ave
Rochester, NY 14642-0002
Phone (585) 275-2100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29370NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Rochester CurrentSince Nov 18, 2022 Accepting new patients
University of Rochester CurrentSince Nov 18, 2022 Accepting new patients

Locations

2613 W Henrietta Rd
Ste B
Rochester, NY 14623
Phone (585) 279-4999

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

Interoperability endpoints

  • Direct secure messaging: mlawler138983@direct.urmc.rochester.edu

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689984000000",
    "number": "1639897788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CRITTENDEN BLVD BOX PSYCH",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-276-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2613 W HENRIETTA RD STE B",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146232327",
            "telephone_number": "585-279-4999",
            "fax_number": "585-473-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IPPOLITO",
        "first_name": "AYODELE",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-16",
        "last_updated": "2023-07-22",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "029370",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "29370",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlawler138983@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": "mlawler138983@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": [
        {
            "first_name": "AYODELE",
            "last_name": "IFAFORE",
            "middle_name": "C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.