Individual provider Active NPI

Jacquelyn Denise Payne, PA-C

  • Physician Assistant
  • Macon, GA
National Provider Identifier
1003381591
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9008 Issued in GA
Practice address
840 Pine St Ste 500
Macon, GA 31201-7530
Phone
(478) 633-8682
Fax
(478) 633-8698
NPI assigned
Oct 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9008 GA Primary

Addresses

Primary practice location

840 Pine St Ste 500
Macon, GA 31201-7530

Mailing address

840 Pine St Ste 500
Macon, GA 31201-7530
Phone (478) 633-8682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20190410001959 GA Practitioner - Physician Assistant 9830430339 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Services of Central GeorgiaGroup PAC ID 9638076730, 300 clinicians

Practice addresses (Care Compare)

1120 Morningside Dr
Perry, GA 31069-2906
Phone (478) 987-3600

777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9008GAMDPhysician Assistant

Organizations & group practices 2

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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1003381591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PINE ST STE 500",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312017530",
            "telephone_number": "478-633-8682",
            "fax_number": "478-633-8698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 PINE ST STE 500",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312017530",
            "telephone_number": "478-633-8682",
            "fax_number": "478-633-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "JACQUELYN",
        "middle_name": "DENISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-10",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.