NPIMap

Individual provider Active NPI

Tedi E. Payne

  • Family Nurse Practitioner
  • El Dorado Springs, MO
National Provider Identifier
1083055800
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2013018590 Issued in MO
Practice address
1317 S State Highway 32
El Dorado Springs, MO 64744-2302
Phone
(417) 876-3333
Fax
(417) 876-4509
NPI assigned
Jul 9, 2013
Last updated
Nov 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2013018590 MO Primary

Addresses

Primary practice location

1317 S State Highway 32
El Dorado Springs, MO 64744-2302

Mailing address

1401 S Park St
El Dorado Springs, MO 64744-2037
Phone (417) 876-2511

Other practice location 1

1401 S Park St
El Dorado Springs, MO 64744-2037
Phone (417) 876-2511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131009000731 MO Practitioner - Nurse Practitioner 8820222755 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cedar County Memorial HospitalGroup PAC ID 7315841129, shared by 5 NPIs, 20 clinicians

Practice addresses (Care Compare)

1317 S State Hwy 32
CCMH Medical Mall Clinic
El Dorado Springs, MO 64744-2302
Phone (417) 876-3333

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Aug 5, 2013 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 6, 2018 Accepting new patients
Cedar County Memorial Hospital CurrentSince Jun 1, 2022 Accepting new patients
Cedar County Memorial Hospital CurrentSince Jun 1, 2022 Accepting new patients
Cedar County Memorial Hospital CurrentSince Jun 15, 2022 Accepting new patients
Mercy Clinic Springfield Communities Family CurrentSince Aug 5, 2013 Accepting new patients
Cedar County Memorial Hospital CurrentSince Jun 1, 2022 Accepting new patients
Cedar County Memorial Hospital Past Accepting new patients
Cedar County Memorial Hospital Past Accepting new patients

Locations

1317 S State Highway 32
El Dorado Springs, MO 64744
Phone (417) 876-3333

1401 S Park St
El Dorado Springs, MO 64744
Phone (417) 876-2511

309 E Hospital Rd
El Dorado Springs, MO 64744
Phone (417) 876-4645

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

807 Owens Mill Rd
Stockton, MO 65785
Phone (417) 276-5500

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1083055800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S PARK ST",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442037",
            "telephone_number": "417-876-2511",
            "fax_number": "417-876-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 S STATE HIGHWAY 32",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442302",
            "telephone_number": "417-876-3333",
            "fax_number": "417-876-4509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 S Park St",
            "address_purpose": "LOCATION",
            "city": "El Dorado Springs",
            "state": "MO",
            "postal_code": "647442037",
            "country_code": "US",
            "telephone_number": "417-876-2511",
            "fax_number": "417-876-3812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "TEDI",
        "middle_name": "E.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-09",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2013018590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Dorado Springs, MO

Sources for this page

Verify at the official NPI Registry.