Brandon C Payne, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10136 Issued in CO

Practice address

4728 Eagleridge Cir Ste 110
Pueblo, CO 81008-2196

Phone

(719) 542-4546

Fax

(719) 542-4548

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2015 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731196800000",
    "number": "1285772301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4728 EAGLERIDGE CIR STE 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082196",
            "telephone_number": "719-542-4546",
            "fax_number": "719-542-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4728 EAGLERIDGE CIR STE 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082196",
            "telephone_number": "719-542-4546",
            "fax_number": "719-542-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "BRANDON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "10136",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CO",
            "license": "50000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33987220",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Montie Lee Paulsen
• Kimberly Dawn Pavlicek, COTA
• Pawel R Bielecki, DDS, PC
• Pawel R Bielecki, DDS, PC (Young at Heart Dentistry)
• Janae Leanna Payen
• Cody Payne, PT, DPT
• Davon Payne, RBT
• Stephanie Payne, D.O.
• Tammy R Payne, LCSW
• Wayne Frank Payne, D.D.S.

• Oral and Maxillofacial Surgery (Dentist) in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.