Individual provider Active NPI

Roxanne M Payne, FNP

  • Family Nurse Practitioner
  • Portland, OR
National Provider Identifier
1295040905
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
200750084NP Issued in OR
Practice address
4805 NE Glisan St
Main Level
Portland, OR 97213-2933
Phone
(503) 215-7901
NPI assigned
Aug 18, 2010
Last updated
Oct 19, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 200750084NP OR Primary

Addresses

Primary practice location

4805 NE Glisan St
Main Level
Portland, OR 97213-2933

Mailing address

PO Box 3158
Portland, OR 97208-3158

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rpayne109900@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101124001070 OR Practitioner - Nurse Practitioner 6800082223 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 27, 2012 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 27, 2012 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 18, 2012 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 1, 2010 Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2010 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 18, 2012 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients
Providence Health & Services Oregon Past Accepting new patients

Locations

810 12th St
Hood River, OR 97031
Phone (541) 386-3911

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

10330 SE 32nd Ave
Ste 205
Portland, OR 97222
Phone (503) 513-8950

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

4805 NE Glisan St
Ste 11N
Portland, OR 97213
Phone (503) 215-1350

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

9135 SW Barnes Rd
Ste 261
Portland, OR 97225
Phone (503) 215-8650

9155 SW Barnes Rd
Ste 238
Portland, OR 97225
Phone (503) 223-7214

9427 SW Barnes Rd
Portland, OR 97225
Phone (503) 203-2040

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

727 S Wahanna Rd
Ste 100
Seaside, OR 97138
Phone (503) 717-7000

Interoperability endpoints

  • Direct secure messaging: rpayne109900@oc.providencedirect.org

Organizations & group practices 10

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

NPI Registry JSON

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1295040905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "address_2": "MAIN LEVEL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "ROXANNE",
        "middle_name": "M",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-18",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200750084NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rpayne109900@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9427 SW Barnes Rd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.