Individual provider Active NPI

Jordan Nicole Gladstone, P.A.-C

  • Physician Assistant
  • Cooperstown, NY
National Provider Identifier
1295085652
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
034759 Issued in NY
Practice address
1 Atwell Rd
Cooperstown, NY 13326
Phone
(607) 547-3456
NPI assigned
Sep 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-03757 NC
Physician Assistant 363A00000X 034759 NY Primary

Addresses

Primary practice location

1 Atwell Rd
Cooperstown, NY 13326

Mailing address

1 Atwell Rd
Cooperstown, NY 13326-1394
Phone (607) 547-3034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121218000008 NC Practitioner - Physician Assistant 3779735881 Reassigns benefits to 1 organization
I20260225000087 NY Practitioner - Physician Assistant 3779735881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mary Imogene Bassett HospitalGroup PAC ID 3779488325, 780 clinicians
Unc Physicians Network LLCGroup PAC ID 5496940546, 985 clinicians

Practice addresses (Care Compare)

1 Atwell Rd
Cooperstown, NY 13326-1301
Phone (607) 547-3480

940 Martin Luther King Jr Blvd
Chapel Hill, NC 27514-2601
Phone (919) 942-5123

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
034759NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Unc Physicians Network LLC CurrentSince Nov 5, 2012 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Jan 5, 2026 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Jan 5, 2026 Accepting new patients

Locations

114 Brady Ct
Cary, NC 27511
Phone (919) 469-1252

6715 McCrimmon Pkwy
Ste 300
Cary, NC 27519
Phone (919) 481-4997

115 Kildaire Park Dr
Ste 108
Cary, NC 27518
Phone (919) 469-1252

940 Martin Luther King Jr Blvd
Chapel Hill, NC 27514
Phone (919) 942-5123

208 Village Walk Dr
Holly Springs, NC 27540
Phone (919) 552-8911

5221 Paramount Pkwy
Ste 220
Morrisville, NC 27560
Phone (984) 215-4110

2000 Perimeter Park Dr
Ste 200
Morrisville, NC 27560
Phone (800) 594-8624

178 Grandview Dr
Cobleskill, NY 12043
Phone (518) 254-3456

1 Atwell Rd
Cooperstown, NY 13326
Phone (607) 547-3480

Organizations & group practices 4

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 2

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": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781222400000",
    "number": "1295085652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ATWELL RD",
            "city": "COOPERSTOWN",
            "state": "NY",
            "postal_code": "133261394",
            "telephone_number": "607-547-3034",
            "fax_number": "607-547-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ATWELL RD",
            "city": "COOPERSTOWN",
            "state": "NY",
            "postal_code": "13326",
            "telephone_number": "607-547-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLADSTONE",
        "first_name": "JORDAN",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-13",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03757",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "034759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cooperstown, NY

Sources for this page

Verify at the official NPI Registry.