Ademola Fawole

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS018734 Issued in PA

Practice address

513 W Chocolate Ave Ste 100
Hershey, PA 17033

Phone

(717) 810-1974

Fax

(717) 704-8476

NPI assigned

Apr 19, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, NJ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

NJ Behavioral Health Services PCGroup PAC ID 0648288712, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• NJ Behavioral Health Services PC

  • Clinical Psychologist
  • Paramus, NJ
  • NPI 1447289376
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group of New Jersey PC

  • Mental Health Counselor
  • Hoboken, NJ
  • NPI 1841949328

  Psychologist

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  PA, Psychologist

  Medicare reassignment NPD
• The Behavioral Health and Wellness Academy

  • Clinical Psychologist
  • Lancaster, PA
  • NPI 1992219588
  NPD
• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959
  NPD (past)

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1871080358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2726 MAXWELL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191361017",
            "telephone_number": "215-939-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 W CHOCOLATE AVE STE 100",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "17033",
            "telephone_number": "717-810-1974",
            "fax_number": "717-704-8476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1427C Province Ter",
            "address_purpose": "LOCATION",
            "city": "Menasha",
            "state": "WI",
            "postal_code": "549527003",
            "country_code": "US",
            "telephone_number": "920-738-9999",
            "fax_number": "920-268-1921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAWOLE",
        "first_name": "ADEMOLA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-19",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS018734",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3565-57",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Faschan, M.D.
• Michael Taylor Faschan, M.D.
• Jens Fassl, MD
• Nima Fattahi
• Tracy B Fausnight, MD
• Khalil Fayad, MBBCH
• Vickie A Fazio, CRNP
• Christopher Fecca
• Mary Lynn Elizabeth Fecile, M.D.
• Karen J Fedash, CRNA

• Psychologist in Hershey, PA
• Providers in Hershey, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.