AGAVE MEDICAL NY, P.C — NPI 1780403501 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1780403501

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103T00000X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist

Box 32 Service Location & ZIP+4

16397 ROAD 37, MADERA, CA, 93636-8224

✓ 9-Digit EDI 837 ZIP+4 (93636-8224)

Practice Phone & Referral Fax

(510) 871-5025

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1780403501 (AGAVE MEDICAL NY, P.C) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1780403501` (NPI-2 Organization / Facility)
Provider / Legal Name	AGAVE MEDICAL NY, P.C
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist NUCC Code: `103T00000X` (Psychologist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	16397 ROAD 37, MADERA, CA, 93636-8224
Practice Telephone / Fax	Tel: (510) 871-5025
Administrative Mailing Address	359 5TH ST UNIT 3, JERSEY CITY, NJ, 07302-2329
Enumeration & Last Sync	Enumerated: 2024-10-08 \| CMS Record Updated: 2026-07-30
Authorized Official	MICHAEL SCAHILL (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

16397 ROAD 37, MADERA, CA, 93636-8224

🗺️ Open in Google Maps 🏥 More Providers in MADERA

🔒 Are you AGAVE MEDICAL NY, P.C? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (103T00000X)

What Does Taxonomy Code 103T00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103T00000X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AGAVE MEDICAL NY, P.C)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YM0800X` — Counselor, Mental Health Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Secondary
`103T00000X` — Psychologist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`103TH0004X` — Psychologist, Health Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Health	State: N/A \| License: `Verified` \| Primary: Secondary
`104100000X` — Social Worker Plain English: Licensed & Credentialed Social Worker	State: N/A \| License: `Verified` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

AGAVE MEDICAL NY, P.C (NPI #1780403501)