Individual provider Active NPI

Tylor Scott Payne, CAA

  • Anesthesiologist Assistant
  • Joplin, MO
National Provider Identifier
1538873807
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
75000128A Issued in IN
Practice address
1102 W 32ND St
Joplin, MO 64804-3503
Phone
(417) 347-1111
NPI assigned
Jan 10, 2023
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 32698366 WI
Anesthesiologist Assistant 367H00000X 75000128A IN Primary

Addresses

Primary practice location

1102 W 32ND St
Joplin, MO 64804-3503

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

8830 S Meridian St
Indianapolis, IN 46217-5029
Phone (317) 274-0275

Other practice location 2

550 University Blvd
Indianapolis, IN 46202-5149
Phone (317) 274-0275

Other practice location 3

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (317) 274-0275

Other practice location 4

705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Phone (317) 274-0275

Other practice location 5

151 Pennsylvania Pkwy
Carmel, IN 46280-1379
Phone (317) 577-4200

Other identifiers 1

IdentifierTypeStateIssuer
1102822179OtherINANTHEM PTAN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tpayne@direct.iuhealth.org Direct
Direct Messaging Address tpayne@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230126001933 MO Practitioner - Anesthesiology Assistant 2062883275 Reassigns benefits to 1 organization
I20230319000044 IN Practitioner - Anesthesiology Assistant 2062883275 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
75000128AINMDAnesthesiologist Assistant
32698366WIMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Anesthesiology Associates, LLC CurrentSince Apr 1, 2023 Accepting new patients
Iu Health Medical Group, LLC CurrentSince Jan 1, 2025 Accepting new patients
Freeman-Oak Hill Health System CurrentSince Jan 25, 2023 Accepting new patients
Indiana University Health Care Associates, Inc CurrentSince Jun 1, 2024 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

5208 Reliable Pkwy
Chicago, IL 60686

151 Pennsylvania Pkwy
Carmel, IN 46280
Phone (317) 817-1100

1130 W Michigan St
Indianapolis, IN 46202
Phone (317) 274-0076

1701 N Senate Blvd
Bldg C6
Indianapolis, IN 46202
Phone (913) 962-2000

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000

705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779

8830 S Meridian St
Indianapolis, IN 46217
Phone (317) 865-5029

1102 W 32nd St
Joplin, MO 64804
Phone (417) 347-1078

307 W 11th St
Lamar, MO 64759
Phone (417) 682-3300

Interoperability endpoints

  • Direct secure messaging: tpayne@direct.iuhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1538873807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 W 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043503",
            "telephone_number": "417-347-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8830 S Meridian St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462175029",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "fax_number": "317-274-0256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 University Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025149",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "fax_number": "317-274-0256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "fax_number": "317-274-0256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "fax_number": "317-274-0256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "151 Pennsylvania Pkwy",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "462801379",
            "country_code": "US",
            "telephone_number": "317-577-4200",
            "fax_number": "317-577-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "TYLOR",
        "middle_name": "SCOTT",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-10",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "WI",
            "license": "32698366",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000128A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PTAN",
            "identifier": "1102822179",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tpayne@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8830 S Meridian St",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462175029",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tpayne@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "151 Pennsylvania Pkwy",
            "city": "Carmel",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462801379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.