Clive Ricketts II, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

023928-01 Issued in NY

Practice address

1468 Madison Ave
New York, NY 10029-6508

Phone

(646) 537-8731

NPI assigned

Sep 18, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Clifton Springs Sanitarium Co

  • General Acute Care Hospital
  • Clifton Springs, NY
  • NPI 1366505463
  Medicare reassignment
• Newark Wayne Community Hospital

  • General Acute Care Hospital
  • Newark, NY
  • NPI 1770671182
  Medicare reassignment
• Rochester General Hospital

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712
  Medicare reassignment
• Newark Wayne Community Hospital

  • General Acute Care Hospital
  • Newark, NY
  • NPI 1346369212
  NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD
• Rochester General Hospital

  • Multi-Specialty Clinic/Center
  • Rochester, NY
  • NPI 1861568594
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1326698572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 JUPITER RD",
            "city": "HIGHLAND MILLS",
            "state": "NY",
            "postal_code": "109302917",
            "telephone_number": "347-831-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "646-537-8731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Driving Park Ave",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NY",
            "postal_code": "145131090",
            "country_code": "US",
            "telephone_number": "315-332-2266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "CLIVE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-18",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023928-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe Elyse Ricke
• Sandra Patricia Rickenbacker, REGISTERED NURSE
• Edd C Ricker, MD, PHD
• Joseph Howard Ricker, PH.D.
• Scott Rickert, MD
• Tonya Ricketts
• Sarah Jane Ricklan, MD, MPHIL
• Samantha Erica Rickman, MA/CCC-SIP
• Jocelyn Olivia Ricks
• Tinisha R Ricks, DPM

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.