WAVERLY MEDICAL ASSOCIATES LLC
NPI 1457757486
Internal Medicine in Waverly, NY

Q: What is Waverly Medical Associates LLC's NPI number?

The NPI number for Waverly Medical Associates LLC is 1457757486. It was assigned to this organization in the NPPES registry on November 19, 2014.

Q: What is Waverly Medical Associates LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since November 19, 2014CLIA 33D2089324 · Microscopy

348 BROAD ST, WAVERLY, NY 14892(607) 821-2444(607) 948-1030 Get Directions Write a Review

NPPES record last updated: September 23, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Waverly Medical Associates Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAVERLY MEDICAL ASSOCIATES LLC (NPI 1457757486) is a healthcare organization registered as an internal medicine in Waverly, New York and active in the NPI registry since November 2014. The organization holds a CLIA Microscopy certificate valid through March 26, 2027 and lists Victor Omamode Idahosa, Owner, as its authorized official.

NPPES Registry Identity

NPI1457757486

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameWAVERLY MEDICAL ASSOCIATES LLC

Location Address348 BROAD STWaverly, NY 14892-1441

Mailing Address348 Broad StWaverly, NY 14892-1441 · (607) 821-2444 · Fax (607) 948-1030

Phone(607) 821-2444

Fax(607) 948-1030

Organization SubpartNo

Authorized OfficialVictor Omamode IdahosaOwner · (607) 821-2444

Enumeration DateNovember 19, 2014

Last NPPES UpdateSeptember 23, 2016

✔ NPI 1457757486 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in NY · 276514

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 275859 (NY)

348 BROAD ST, Waverly, NY 14892

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Waverly Medical Associates Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Waverly Medical Associates LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Victor Idahosa, MD

Internal Medicine

NPI 1528226677

348 BROAD ST
Waverly, NY 14892

(607) 821-2444

✔ PECOS✔ Accepts MedicareSame address

Ejiro Agboro Idahosa, M.D

Psychiatry

NPI 1104089390

555 SAINT JOSEPHS BLVD
Elmira, NY 14901

(607) 737-7002

✔ PECOS✔ Accepts Medicare15 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 33D2089324

Waverly Medical Associates LLC · Waverly, NY

Active · expires Mar 26, 2027

CLIA Number33D2089324

Laboratory TypePhysician Office

Certificate Effective DateFebruary 4, 2015

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorDr. Victor O. Idahosa

Laboratory Phone(607) 821-2444

Laboratory LocationWaverly Medical Associates LLC348 Broad Street, Waverly, NY 14892

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Waverly Medical Associates LLC's NPI number?

The NPI number for Waverly Medical Associates LLC is 1457757486. It was assigned to this organization in the NPPES registry on November 19, 2014.

Where is Waverly Medical Associates LLC located?

Waverly Medical Associates LLC is located at 348 Broad St, Waverly, NY 14892. The listed phone number is (607) 821-2444.

What is Waverly Medical Associates LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Waverly Medical Associates LLC enrolled in Medicare?

Yes. Waverly Medical Associates LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Waverly Medical Associates LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Waverly Medical Associates LLC, in Internal Medicine and Psychiatry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Waverly Medical Associates LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 33D2089324) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Waverly Medical Associates LLC was last updated on September 23, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.