Individual provider Active NPI

Pamela J Paine, AUD

  • Audiologist
  • Vernon, CT
National Provider Identifier
1285631853
Registry record updated Jan 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
000153 Issued in CT
Practice address
27 Hartford Tpke
Vernon, CT 06066-5245
Phone
(860) 646-7900
Fax
(860) 646-7792
NPI assigned
Jun 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X
Audiologist 231H00000X 000153 CT Primary

Addresses

Primary practice location

27 Hartford Tpke
Vernon, CT 06066-5245

Mailing address

8800 SE Sunnyside Rd Ste 300N
Clackamas, OR 97015-5703
Phone (281) 286-2999

Other identifiers 1

IdentifierTypeStateIssuer
4062832MedicaidCT

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

State licenses

LicenseStateTypeSpecialty
000153CTMDAthletic Trainer

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1285631853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8800 SE SUNNYSIDE RD STE 300N",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155703",
            "telephone_number": "281-286-2999",
            "fax_number": "512-607-4893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 HARTFORD TPKE",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060665245",
            "telephone_number": "860-646-7900",
            "fax_number": "860-646-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAINE",
        "first_name": "PAMELA",
        "middle_name": "J",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CT",
            "license": "000153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4062832",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.

Verify at the official NPI Registry.