Active NPI
Crystal L Payne, LCSW
- Clinical Social Worker
- McDonough, GA
National Provider Identifier
1043720576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW007335
- Practice address
- 2190 Grant Ave
McDonough, GA 30252-7699 - Phone
- (404) 834-7939
- NPI assigned
- Oct 11, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MSW008041 | GA | |
| Clinical Social Worker | 1041C0700X | CSW007335 | GA | Primary |
Addresses
Primary practice location
2190 Grant Ave
McDonough, GA 30252-7699
Mailing address
2190 Grant Ave
McDonough, GA 30252-7699
Phone (404) 834-7939
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW007335 | GA | MD | Clinical Social Worker |
| MSW008041 | GA | MD | Student in an Organized Health Care Education/Training Program |
Organizations & group practices 1
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": "1507680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649894400000",
"number": "1043720576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2190 GRANT AVE",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302527699",
"telephone_number": "404-834-7939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2190 GRANT AVE",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302527699",
"telephone_number": "404-834-7939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "CRYSTAL",
"middle_name": "L",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-11",
"last_updated": "2022-04-14",
"certification_date": "2022-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "GA",
"license": "MSW008041",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW007335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McDonough, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.
- 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.