NPIMap

Individual provider Active NPI

Maryellen Blevins, PA

  • Physician Assistant
  • Carthage, NY
National Provider Identifier
1104937945
Registry record updated Feb 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005666 Issued in NY
Practice address
3 Bridge St.
Carthage, NY 13619
Phone
(315) 493-3333
NPI assigned
Aug 31, 2006
Last updated
Feb 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005666 NY Primary

Addresses

Primary practice location

3 Bridge St.
Carthage, NY 13619

Mailing address

1001 West St.
Carthage, NY 13619
Phone (315) 493-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040616000246 NY Practitioner - Physician Assistant 6002890159 Reassigns benefits to 5 organizations
I20230725000826 OH Practitioner - Physician Assistant 6002890159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Country Orthopaedic Group PCGroup PAC ID 8426043381, 18 clinicians

Practice addresses (Care Compare)

1571 Washington St
Suite 201
Watertown, NY 13601-9304
Phone (315) 782-1650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5666NYMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Claxton Medical PC Physician Assistant CurrentSince Nov 1, 2025 Accepting new patients
Carthage Area Hospital Inc CurrentSince May 10, 2016 Accepting new patients
Carthage Area Hospital, Inc. CurrentSince Jun 1, 2025 Accepting new patients
Claxton Medical PC CurrentSince Nov 1, 2025 Accepting new patients
Wellnow Urgent Care, PC CurrentSince Feb 13, 2023 Accepting new patients
Carthage Area Hospital, Inc. CurrentSince May 10, 2016 Accepting new patients
Claxton-Hepburn Medical Center Past Accepting new patients
University Surgical Associates, LLP Past Accepting new patients
Carthage Area Hospital Inc. Past Accepting new patients

Locations

4 Fuller St
Alexandria Bay, NY 13607
Phone (315) 482-1277

1001 West St
Carthage, NY 13619
Phone (315) 493-1000

3 Bridge St
Carthage, NY 13619
Phone (315) 493-3300

6870 E Genesee St
Fayetteville, NY 13066
Phone (315) 679-4367

446 Fairview Ave
Ste 200
Hudson, NY 12534
Phone (518) 267-3496

7375 Oswego Rd
#1
Liverpool, NY 13090
Phone (315) 291-0064

3 Lyon Pl
Ogdensburg, NY 13669
Phone (315) 394-7542

Interoperability endpoints

  • Direct secure messaging: maryellenblevinspa@ncog.medentdirect.com

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1104937945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST ST.",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "13619",
            "telephone_number": "315-493-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BRIDGE ST.",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "13619",
            "telephone_number": "315-493-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEVINS",
        "first_name": "MARYELLEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, NY

Sources for this page

Verify at the official NPI Registry.