Individual provider Active NPI

Jane W Payne, PHD

  • Clinical Psychologist
  • Lyndhurst, OH
National Provider Identifier
1073621389
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4367 Issued in OH
Practice address
5001 Mayfield Rd
200
Lyndhurst, OH 44124-2602
Phone
(216) 291-4000
Fax
(216) 291-4111
NPI assigned
Aug 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4367 OH Primary

Addresses

Primary practice location

5001 Mayfield Rd
200
Lyndhurst, OH 44124-2602

Mailing address

3872 E Harbor Light Landing Dr
200
Port Clinton, OH 43452-3877
Phone (419) 734-3333

Other identifiers 6

IdentifierTypeStateIssuer
620003450OtherOHRAILROAD MEDICARE
6100372OtherOHEVERCARE
042501002OtherOHMAGELLAN
000000137848OtherOHANTHEM
0182387MedicaidOH
84523OtherOHQUALCHOICE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1073621389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3872 E HARBOR LIGHT LANDING DR",
            "address_2": "200",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434523877",
            "telephone_number": "419-734-3333",
            "fax_number": "877-734-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 MAYFIELD RD",
            "address_2": "200",
            "city": "LYNDHURST",
            "state": "OH",
            "postal_code": "441242602",
            "telephone_number": "216-291-4000",
            "fax_number": "216-291-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "JANE",
        "middle_name": "W",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-27",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "620003450",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "6100372",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "042501002",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000137848",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0182387",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "84523",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyndhurst, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.