Active NPI
Audrey Elizabeth Payne
- Physician Assistant
- Santa Cruz, CA
National Provider Identifier
1245682194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 53891
- Practice address
- 615 Ocean St
Santa Cruz, CA 95060-4005 - Phone
- (831) 425-7991
- Fax
- (831) 425-7346
- NPI assigned
- Jul 4, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 53891 | CA | Primary |
Addresses
Primary practice location
615 Ocean St
Santa Cruz, CA 95060-4005
Mailing address
615 Ocean St
Santa Cruz, CA 95060-4005
Phone (831) 425-7991
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53891 | CA | MD | Dentist |
Interoperability endpoints
- axp593pcs@m1492.primeclinicalsystems.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536537600000",
"number": "1245682194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 OCEAN ST",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950604005",
"telephone_number": "831-425-7991",
"fax_number": "831-425-7346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 OCEAN ST",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950604005",
"telephone_number": "831-425-7991",
"fax_number": "831-425-7346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "AUDREY",
"middle_name": "ELIZABETH",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-04",
"last_updated": "2018-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "53891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.