Agezi Igboko

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

348029 Issued in NY

Practice address

950 County Rd
Elmira, NY 14903

Phone

(607) 796-5900

NPI assigned

May 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, TX2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Southern Tier Dermatology & Aesthetics

  • Dermatology Physician
  • Endwell, NY
  • NPI 1275589558

  Single Specialty

  NPD
• Sanova Dermatology PLLC

  • Dermatology Physician
  • Austin, TX
  • NPI 1689957169

  Single Specialty

  NPD

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1790350882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 CAPRIOLE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300620300",
            "telephone_number": "919-630-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 COUNTY RD",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "14903",
            "telephone_number": "607-796-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IGBOKO",
        "first_name": "AGEZI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2023-03-30",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "348029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwin P Hutsal, M.D.
• Mai Huynh, DDS
• Debra L Hyde, MSW
• Catherine Iacono
• Colleen M Iavarone, RD, CDN, CNSD
• Imaging Radiology Associates,LLC
• Marc Immerman, M.D.
• Brent S. Ingerick, DO
• Integrated Counseling Services
• Integrated Psychological Health & Wellness PLLC

• Nurse Practitioner in Elmira, NY
• Providers in Elmira, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.