Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ryan J Blackwell

Individual provider Physician Assistant · NPI 1164996948

Ryan J Blackwell is a Physician Assistant in Cooperstown, New York. Qualified in 2019, 7 years ago. Practices with Mary Imogene Bassett Hospital, a 779-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
7
Licensed in
NY
In the registry since
2019
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Practice location Address checks out

1 Atwell Rd
Cooperstown, NY 13326
Phone: (607) 547-3672
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098 — (573) 596-0035
  • 4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098 — (573) 596-0035
  • 30 13th St, Havre, MT 59501 — (406) 262-1305

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 029977 (NY)

Record details

NPI number1164996948
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 15, 2019
Last updated in NPPESNovember 19, 2025
Certification dateNovember 19, 2025
Mailing address1 Atwell Rd, Cooperstown, NY 13326

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Mary Imogene Bassett Hospital — 779 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Cooperstown