Matthew Ryan Blackert, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.024115 Issued in OH

Practice address

6514 Ivyhill Dr NW
Canal Fulton, OH 44614-9432

Phone

(330) 703-0772

NPI assigned

Jan 22, 2021

Last updated

Jan 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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 OH

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

State licenses

Practice roles

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.

• Beneficial Health Inc

  • General Practice Physician
  • Hartville, OH
  • NPI 1093080079
  Medicare reassignment
• Knop Chiropractic Inc

  • Rehabilitation Chiropractor
  • Hartville, OH
  • NPI 1134394174
  NPD (past)

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1689264723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6514 IVYHILL DR NW",
            "city": "CANAL FULTON",
            "state": "OH",
            "postal_code": "446149432",
            "telephone_number": "330-703-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6514 IVYHILL DR NW",
            "city": "CANAL FULTON",
            "state": "OH",
            "postal_code": "446149432",
            "telephone_number": "330-703-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKERT",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.024115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aria LTD
• Asbury Counseling, LLC
• Angela Barbitta
• James Bertram
• Kenneth J Biros, DO
• Harriet A Boswell, INDEPENDENT PROVIDER
• Kenneth Franklin Bowersox Jr., LMT
• Faith McKenzie Brady, CDCES, RN
• Greta Brown, M.A.
• Lisa Burg, PSY.S.

• Family Nurse Practitioner in Canal Fulton, OH
• Providers in Canal Fulton, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.