NPIMap

Individual provider Active NPI

Jerald Payne, LSCSW, LCSW

  • Clinical Social Worker
  • Kansas City, MO
National Provider Identifier
1801932124
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2001031825 Issued in MO
Practice address
3914 Washington St
Kansas City, MO 64111-2925
Phone
(816) 864-4201
Fax
(816) 561-8199
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2001031825 MO Primary
Clinical Social Worker 1041C0700X 2169 KS

Addresses

Primary practice location

3914 Washington St
Kansas City, MO 64111-2925

Mailing address

3914 Washington St
Kansas City, MO 64111-2925
Phone (816) 864-4201

Other identifiers 3

IdentifierTypeStateIssuer
495380420MedicaidMO
200256670-AMedicaidKS
495380404MedicaidMO

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2169KSMDClinical Social Worker
2001031825MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
J.P. and Associates, Counseling and Consultation Services Clinical Current Accepting new patients
Cognitions Anxiety and Depression Treatment Services, LLC Clinical Current Accepting new patients
Dr.Harry R. Davidson, PHD LLC Past Accepting new patients
Midtown Psychological Services, Inc. Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428624000000",
    "number": "1801932124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3914 WASHINGTON ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112925",
            "telephone_number": "816-864-4201",
            "fax_number": "816-561-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3914 WASHINGTON ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112925",
            "telephone_number": "816-864-4201",
            "fax_number": "816-561-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "JERALD",
        "name_prefix": "Mr.",
        "credential": "LSCSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2015-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2001031825",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "2169",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495380420",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200256670-A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495380404",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.