Individual provider Active NPI

Kathey J. Payne, CRNA

  • Certified Registered Nurse Anesthetist
  • Winder, GA
National Provider Identifier
1124004270
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN050346 Issued in GA
Practice address
316 N Broad St
Winder, GA 30680-2150
Phone
(678) 838-1585
NPI assigned
Dec 21, 2005
Last updated
Aug 20, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN050346 GA Primary

Addresses

Primary practice location

316 N Broad St
Winder, GA 30680-2150

Mailing address

PO Box 724928
Atlanta, GA 31139-9028
Phone (678) 838-1585

Other identifiers 1

IdentifierTypeStateIssuer
000954313EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070410000490 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5698870228 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Resource Anesthesia Barrow Inc.Group PAC ID 2769633114, 9 clinicians

Practice addresses (Care Compare)

138 W Athens St
Winder, GA 30680-1776
Phone (770) 307-3922

316 N Broad St
Winder, GA 30680-1776
Phone (770) 867-3400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN050346GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Walton Anesthesia Associates, PC CurrentSince Jul 12, 2013 Accepting new patients
Resource Anesthesia Barrow Inc. Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2012 Accepting new patients
Ips of Conyers LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
New London Anesthesia & Pain Consultants PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Rockdale Anesthesia Services, P.C. PastSince Mar 1, 2003 Accepting new patients

Locations

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

330 Alcovy St
Monroe, GA 30655
Phone (770) 267-1789

138 W Athens St
Winder, GA 30680
Phone (770) 307-3922

316 N Broad St
Winder, GA 30680
Phone (770) 307-5354

12752 Kingston Pike
Ste E202
Knoxville, TN 37934
Phone (877) 277-9030

Organizations & group practices 5

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 1

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": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250726400000",
    "number": "1124004270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 724928",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311399028",
            "telephone_number": "678-838-1585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 N BROAD ST",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306802150",
            "telephone_number": "678-838-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "KATHEY",
        "middle_name": "J.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2009-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN050346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000954313E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winder, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.