Sandra L. Payne, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

KY6437 Issued in KY

Practice address

John P Rakutt DMD PSC
801 Barret Avenue #107
Louisville, KY 40204

Phone

(502) 582-2004

Fax

(502) 582-2032

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Rakutt and Payne Dental PSC

  • General Practice Dentistry
  • Louisville, KY
  • NPI 1023435823
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710072137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "JOHN P RAKUTT DMD PSC",
            "address_2": "801 BARRET AVENUE #107",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40204",
            "telephone_number": "502-582-2004",
            "fax_number": "502-582-2032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "JOHN P RAKUTT DMD PSC",
            "address_2": "801 BARRET AVENUE #107",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40204",
            "telephone_number": "502-582-2004",
            "fax_number": "502-582-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "SANDRA",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "KY6437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60064375",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL",
            "identifier": "0004999",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Parker Payne
• Olivia Payne, RBT
• Peyton Payne
• Rachel Payne, RBT
• Ronald Payne
• Shorye Payne, MD
• Tiffani Payne
• Walter Payne Jr.
• Connie N. Paynter, LCSW
• Mary Davis Paynter, D.M.D.

• Dentist in Louisville, KY
• Providers in Louisville, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.