Individual provider Active NPI

Ronald James Blackwell, DPT

  • Physical Therapist
  • Nutley, NJ
National Provider Identifier
1548741069
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01812400 Issued in NJ
Practice address
237 Franklin Ave
Nutley, NJ 07110-2708
Phone
(973) 562-0080
Fax
(973) 562-0081
NPI assigned
Aug 23, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA01812400 NJ Primary

Addresses

Primary practice location

237 Franklin Ave
Nutley, NJ 07110-2708

Mailing address

11 Eagle Rock Ave Ste 201
East Hanover, NJ 07936-3167
Phone (973) 887-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180927001765 NJ Practitioner - Physical Therapist in Private Practice 4688925886 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sportscare of America, PCGroup PAC ID 9032213756, 132 clinicians

Practice addresses (Care Compare)

317 Brick Blvd
Suite 120
Brick, NJ 08723-6031
Phone (732) 255-9500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sportscare of America, PC Physical Therapist CurrentSince Aug 21, 2018 Accepting new patients
United Sports Care & Physical Therapy Physical Therapist CurrentSince Aug 21, 2018 Accepting new patients
Sportscare Institute, Inc. Physical Therapist Past Accepting new patients

Locations

47 S Washington Ave
Bergenfield, NJ 07621
Phone (201) 384-2525

317 Brick Blvd
Ste 120
Brick, NJ 08723
Phone (732) 255-9500

1161 Burnt Tavern Rd
Brick, NJ 08724
Phone (732) 458-1255

197 Ridgedale Ave
Cedar Knolls, NJ 07927
Phone (973) 292-0700

11 Eagle Rock Ave
Ste 201
East Hanover, NJ 07936
Phone (973) 887-0115

237 Franklin Ave
Nutley, NJ 07110
Phone (973) 562-0080

80 Oak Hill Rd
Red Bank, NJ 07701
Phone (732) 741-2313

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1548741069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 EAGLE ROCK AVE STE 201",
            "city": "EAST HANOVER",
            "state": "NJ",
            "postal_code": "079363167",
            "telephone_number": "973-887-9000",
            "fax_number": "973-887-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 FRANKLIN AVE",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071102708",
            "telephone_number": "973-562-0080",
            "fax_number": "973-562-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "RONALD",
        "middle_name": "JAMES",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01812400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nutley, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.