Active NPI
Suzanne Demulder, P.A.
- Physician Assistant
- Cooperstown, NY
National Provider Identifier
1790739209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001215
- Practice address
- 1 Atwell Rd
Cooperstown, NY 13326-1301 - Phone
- (607) 547-3909
- Fax
- (607) 547-6325
- NPI assigned
- May 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001215 | NY | Primary |
Addresses
Primary practice location
1 Atwell Rd
Cooperstown, NY 13326-1301
Mailing address
PO Box 725
Cooperstown, NY 13326-0725
Phone (607) 547-3909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02138003 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 92.62 of 100
- Quality
- 77.97
- Promoting interoperability
- 98
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001215 | NY | MD | Physician Assistant |
Interoperability endpoints
- sdemulder5820@bassett.direct-ci.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1790739209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 725",
"city": "COOPERSTOWN",
"state": "NY",
"postal_code": "133260725",
"telephone_number": "607-547-3909",
"fax_number": "607-547-6325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 ATWELL RD",
"city": "COOPERSTOWN",
"state": "NY",
"postal_code": "133261301",
"telephone_number": "607-547-3909",
"fax_number": "607-547-6325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMULDER",
"first_name": "SUZANNE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-20",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "001215",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02138003",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Cooperstown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.