Active NPI
Susan H Payne, O.D.
- Optometrist
- Sun City Center, FL
National Provider Identifier
1497752356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC3517
- Practice address
- 4051 Upper Creek Dr
Ste 107
Sun City Center, FL 33573-6825 - Phone
- (813) 634-8877
- Fax
- (813) 634-2266
- NPI assigned
- Jul 6, 2005
- Last updated
- Jul 24, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC3517 | FL | Primary |
Addresses
Primary practice location
4051 Upper Creek Dr
Ste 107
Sun City Center, FL 33573-6825
Mailing address
403 Vonderburg Dr
Ste 101
Brandon, FL 33511-5982
Phone (813) 681-1122
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 620559300 | Medicaid | FL | |
| 7286206 | Other | FL | AETNA |
| 20976 | Other | FL | BCBS FLORIDA |
| 6599633 | Other | NY | GHI |
| 2508546 | Other | FL | AENTA |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gregory L Henderson MD Facs Inc | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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": "1120608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1497752356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 VONDERBURG DR",
"address_2": "STE 101",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115982",
"telephone_number": "813-681-1122",
"fax_number": "813-684-4924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4051 UPPER CREEK DR",
"address_2": "STE 107",
"city": "SUN CITY CENTER",
"state": "FL",
"postal_code": "335736825",
"telephone_number": "813-634-8877",
"fax_number": "813-634-2266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "SUSAN",
"middle_name": "H",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-06",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC3517",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "620559300",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7286206",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS FLORIDA",
"identifier": "20976",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "6599633",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AENTA",
"identifier": "2508546",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sun City Center, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.