Individual provider Active NPI

Pamela Rose Blatkiewicz

  • Family Nurse Practitioner
  • Mount Laurel, NJ
National Provider Identifier
1669962304
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00817900 Issued in NJ
Practice address
501 Fellowship Rd Ste 101
Mount Laurel, NJ 08054-3419
Phone
(856) 642-2133
NPI assigned
May 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NR18788300 NJ
Registered Nurse 163W00000X RN689771 PA
Family Nurse Practitioner 363LF0000X SP018879 PA
Family Nurse Practitioner 363LF0000X 26NJ00817900 NJ Primary

Addresses

Primary practice location

501 Fellowship Rd Ste 101
Mount Laurel, NJ 08054-3419

Mailing address

1 Federal St Ste 200
Camden, NJ 08103-1088
Phone (848) 288-6935

Other practice location 1

15000 Midlantic Dr Ste 102
Mount Laurel, NJ 08054-1573
Phone (855) 727-2465

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20180807000009 NJ Practitioner - Nurse Practitioner 8325396419 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
CMC Department of Medicine Group PAGroup PAC ID 2163335878, 474 clinicians

Practice addresses (Care Compare)

501 Fellowship Rd
Suite 101
Mount Laurel, NJ 08054-3419
Phone (856) 642-2133

Hospital & facility affiliations

  • Cooper University Hospital Hospital, Camden, NJ, CCN 310014

Merit-based Incentive Payment System (MIPS)

Final score
91.83 of 100Reported as group
Quality
88.78
Promoting interoperability
99
Improvement activities
40
Cost
74.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN689771PAMDRegistered Nurse
26NJ00817900NJMDFamily Nurse Practitioner
SP018879PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ra Pain Services PA CurrentSince May 29, 2018 Accepting new patients
CMC Department of Medicine Group PA CurrentSince Jul 31, 2023 Accepting new patients
Freeman Pain Institute PA Past Accepting new patients

Locations

3 Cooper Plz
Rm 311
Camden, NJ 08103
Phone (856) 342-2034

1 Federal St
Ste 200
Camden, NJ 08103
Phone (848) 288-6935

3 Cooper Plz
Rm 215
Camden, NJ 08103
Phone (856) 342-2439

2201 Chapel Ave W
Cherry Hill, NJ 08002
Phone (856) 488-6500

807 N Haddon Ave
Ste 1
Haddonfield, NJ 08033
Phone (856) 330-6260

1801 New Rd
#B
Linwood, NJ 08221

1801 New Rd
Ste Bc
Linwood, NJ 08221
Phone (855) 727-2465

309 Bridgeboro Rd
Moorestown, NJ 08057
Phone (856) 439-2000

400 W Route 38
Moorestown, NJ 08057
Phone (856) 270-4000

130 Gaither Dr
Ste 160
Mount Laurel, NJ 08054
Phone (609) 722-7000

15000 Midlantic Dr
Ste 102
Mount Laurel, NJ 08054
Phone (855) 727-2465

501 Fellowship Rd
Ste 101
Mount Laurel, NJ 08054
Phone (856) 963-3572

151 Fries Mill Rd
Ste 202
Turnersville, NJ 08012
Phone (855) 727-2465

218 Sunset Rd
Willingboro, NJ 08046
Phone (609) 835-2900

Interoperability endpoints

  • Direct secure messaging: pblatkiewitcz170557@direct.cooperhealth.edu

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 and National Provider Directory roles.

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": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1669962304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL ST STE 200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031088",
            "telephone_number": "848-288-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 FELLOWSHIP RD STE 101",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543419",
            "telephone_number": "856-642-2133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15000 Midlantic Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mount Laurel",
            "state": "NJ",
            "postal_code": "080541573",
            "country_code": "US",
            "telephone_number": "855-727-2465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLATKIEWICZ",
        "first_name": "PAMELA",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-17",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR18788300",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN689771",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP018879",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00817900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Laurel, NJ

Sources for this page

Verify at the official NPI Registry.