NPIMap

Individual provider Active NPI

Oluwole Ayodeji Tairu, MD

  • Diagnostic Radiology Physician
  • Newark, NJ
National Provider Identifier
1912133109
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
25MA09688800 Issued in NJ
Practice address
150 Bergen St Level C
Newark, NJ 07103-2496
Phone
(973) 972-2161
Fax
(973) 972-2307
NPI assigned
Jun 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 275287 NY
Diagnostic Radiology Physician 2085R0202X 25MA09688800 NJ Primary

Addresses

Primary practice location

150 Bergen St Level C
Newark, NJ 07103-2496

Mailing address

30 Bergen St Admc 12 1205
Newark, NJ 07107-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140826002112 NY Practitioner - Diagnostic Radiology 0042438400 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Albert Einstein College of Medicine of Yeshiva University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-9876

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA09688800NJMDDiagnostic Radiology Physician
275287NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbiadoctors/Newyork-Presbyterianimaging CurrentSince Apr 10, 2019 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Apr 10, 2019 Accepting new patients
Trustees of Columbia University in the City of New York Diagnostic Radiology CurrentSince Apr 10, 2019 Accepting new patients
Trustees of Columbia University in the City of New York Diagnostic Radiology CurrentSince Apr 10, 2019 Accepting new patients
Columbia/Newyork-Presbyterian Advanced Imaging Inc. CurrentSince Nov 23, 2024 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Trustees of Columbia University in the City of New York Past Accepting new patients

Locations

630 W 168th St
#28
New York, NY 10032
Phone (212) 305-1948

722 W 168th St
New York, NY 10032
Phone (212) 305-6754

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
#4100
New York, NY 10032
Phone (212) 305-5123

Interoperability endpoints

  • Direct secure messaging: olt9010@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436918400000",
    "number": "1912133109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BERGEN ST ADMC 12 1205",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BERGEN ST LEVEL C",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032496",
            "telephone_number": "973-972-2161",
            "fax_number": "973-972-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIRU",
        "first_name": "OLUWOLE",
        "middle_name": "AYODEJI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2015-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "275287",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA09688800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.