Individual provider Active NPI

Annette R Payot, CNM

  • Advanced Practice Midwife
  • Berwyn, IL
National Provider Identifier
1376730366
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
209006749 Issued in IL
Practice address
6201 Roosevelt Rd
Berwyn, IL 60402-1108
Phone
(708) 386-0845
Fax
(708) 386-8472
NPI assigned
Oct 3, 2007
Last updated
Dec 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 209006749 IL Primary

Addresses

Primary practice location

6201 Roosevelt Rd
Berwyn, IL 60402-1108

Mailing address

6201 Roosevelt Rd
Berwyn, IL 60402-1108
Phone (708) 386-0845

Other identifiers 3

IdentifierTypeStateIssuer
041345892OtherILMSN
209006749OtherILILLINOIS LICENSE
01621679OtherILBCBS GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080423000332 IL Practitioner - Certified Nurse Midwife (CNM) 2365520988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PCC Community Wellness CenterGroup PAC ID 1557270139, 91 clinicians

Practice addresses (Care Compare)

14 Lake St
Oak Park, IL 60302-2606
Phone 7083830113220005

6201 Roosevelt Rd
Berwyn, IL 60402-1108
Phone (708) 386-0845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
PCC Community Wellness Center CurrentSince Jan 16, 2010 Accepting new patients
PCC Community Wellness Center CurrentSince Jan 16, 2010 Accepting new patients
PCC Community Wellness Center Past Accepting new patients

Locations

6201 Roosevelt Rd
Berwyn, IL 60402
Phone (708) 386-0845

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

Interoperability endpoints

  • Direct secure messaging: annette.payot.1@13158.direct.athenahealth.com

Organizations & group practices 3

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": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1376730366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 ROOSEVELT RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604021108",
            "telephone_number": "708-386-0845",
            "fax_number": "708-386-8472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 ROOSEVELT RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604021108",
            "telephone_number": "708-386-0845",
            "fax_number": "708-386-8472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYOT",
        "first_name": "ANNETTE",
        "middle_name": "R",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-03",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IL",
            "license": "209006749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MSN",
            "identifier": "041345892",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSE",
            "identifier": "209006749",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "01621679",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.