Individual provider Active NPI

Tolani Ajagbe, M.D.

  • Addiction Psychiatry Physician
  • Syracuse, NY
National Provider Identifier
1730462656
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
License
283818 Issued in NY
Practice address
505 Irving Ave
Syracuse, NY 13210-1718
Phone
(315) 464-5540
NPI assigned
Sep 27, 2011
Last updated
Jun 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry Physician 2084P0802X 283818 NY Primary

Addresses

Primary practice location

505 Irving Ave
Syracuse, NY 13210-1718

Mailing address

505 Irving Ave
Syracuse, NY 13210-1718
Phone (315) 464-5540

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161019000284 NY Practitioner - Psychiatry 4183912488 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Psychiatry Faculty Practice, IncGroup PAC ID 9234458530, 90 clinicians
Crouse Health Hospital IncGroup PAC ID 9739173774, 155 clinicians

Practice addresses (Care Compare)

713 Harrison St
BLDG 3
Syracuse, NY 13210-2305
Phone (315) 464-3265

736 Irving Ave
Syracuse, NY 13210-1602
Phone (315) 470-7111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Faculty Practice, Inc. CurrentSince Nov 1, 2016 Accepting new patients
Crouse Health Hospital, Inc. CurrentSince Mar 14, 2018 Accepting new patients
Crouse Health Hospital Inc CurrentSince Mar 14, 2018 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

Interoperability endpoints

  • Direct secure messaging: tajagbe11876@direct.upstate.edu

Organizations & group practices 5

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 1

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": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1730462656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 IRVING AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101718",
            "telephone_number": "315-464-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 IRVING AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101718",
            "telephone_number": "315-464-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAGBE",
        "first_name": "TOLANI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-27",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NY",
            "license": "283818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.