Active NPI
Susannah Rule Payne, DDS
- Dentist
- San Antonio, TX
National Provider Identifier
1154640787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31134
- Practice address
- 4118 McCullough Ave Ste 14
San Antonio, TX 78212-1905 - Phone
- (210) 824-2111
- NPI assigned
- May 21, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 31134 | TX | Primary |
Addresses
Primary practice location
4118 McCullough Ave Ste 14
San Antonio, TX 78212-1905
Mailing address
1717 N 35TH St
Apt 8
Seattle, WA 98103-9048
Phone (210) 386-9272
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260326000074 | TX | Order and Referring Only - Dentist | 2264734466 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31134 | TX | MD | Dentist |
Interoperability endpoints
- spayne62186@direct.utmsa.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566172800000",
"number": "1154640787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 N 35TH ST",
"address_2": "APT 8",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981039048",
"telephone_number": "210-386-9272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4118 MCCULLOUGH AVE STE 14",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782121905",
"telephone_number": "210-824-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "SUSANNAH",
"middle_name": "RULE",
"name_prefix": "Ms.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-21",
"last_updated": "2019-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "31134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.