Individual provider Active NPI

Alex Payne, D.O.

  • Addiction Medicine (Internal Medicine) Physician
  • Elyria, OH
National Provider Identifier
1164879094
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
License
34.014141 Issued in OH
Practice address
174 Midway Blvd
Elyria, OH 44035-2786
Phone
(440) 723-8997
NPI assigned
May 20, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Addiction Medicine (Internal Medicine) Physician 207RA0401X 34.014141 OH Primary
Internal Medicine Physician 207R00000X 34.014141 OH

Addresses

Primary practice location

174 Midway Blvd
Elyria, OH 44035-2786

Mailing address

174 Midway Blvd
Elyria, OH 44035-2786
Phone (440) 723-8997

Other practice location 1

87 Conservatory Dr
Barberton, OH 44203-4291
Phone (234) 334-0303

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230316002784 OH Practitioner - Internal Medicine 8527460799 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.014141OHMDAddiction Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Treatment Centers Oh-VII, LLC CurrentSince Oct 21, 2024 Accepting new patients
Pinnacle Treatment Centers Oh-III, LLC CurrentSince Oct 21, 2024 Accepting new patients

Locations

87 Conservatory Dr
Barberton, OH 44203
Phone (234) 334-0303

174 Midway Blvd
Elyria, OH 44035
Phone (440) 324-5199

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1164879094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 MIDWAY BLVD",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440352786",
            "telephone_number": "440-723-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 MIDWAY BLVD",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440352786",
            "telephone_number": "440-723-8997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "87 Conservatory Dr",
            "address_purpose": "LOCATION",
            "city": "Barberton",
            "state": "OH",
            "postal_code": "442034291",
            "country_code": "US",
            "telephone_number": "234-334-0303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "ALEX",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-20",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "OH",
            "license": "34.014141",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34.014141",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

Verify at the official NPI Registry.