Otis Edd Payne, M.D.,PS

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD00010587 Issued in WA

Legal business name

OTIS EDD PAYNE, M.D.,PS

Practice address

18015 53Rd Ave NE
Lake Forest Park, WA 98155-4361

Phone

(206) 427-2171

Fax

(425) 670-8293

NPI assigned

Aug 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Otis Edd Payne, M.D.

Title

President

Phone

(206) 427-2171

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1073705166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18015 53RD AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981554361",
            "telephone_number": "206-427-2171",
            "fax_number": "425-670-8293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18015 53RD AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981554361",
            "telephone_number": "206-427-2171",
            "fax_number": "425-670-8293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTIS EDD PAYNE, M.D.,PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "OTIS",
        "authorized_official_middle_name": "EDD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-427-2171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00010587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1199009",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "G8801577",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nina Svino DDS PLLC
• Northwest Kidney Centers
• Dijana Novak
• Rebecca Lynn Olson, ARNP
• Sandra Oreilly, RN
• Marilyn Alice Overcast, LMT
• Rebecca Anne Paige, L.M.P.
• Tina Marie Palmer, LMP
• Robyn Phillips-Madson, DO
• Esther Ra, D.D.S.

• Psychiatry Physician in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; 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.