Melissa S Payne Wagner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070013020 Issued in IL

Practice address

3266 Sycamore Rd
Dekalb, IL 60115-9621

Phone

(815) 756-8524

Fax

(815) 756-1841

NPI assigned

Dec 13, 2005

Last updated

Apr 26, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Melissa S Payne Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Rehabilitation and Sports Medicine Associates, Inc.Group PAC ID 6901887041, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northern Rehabilitation & Sports Medicine Associates, Inc.

  • Physical Therapist
  • Dekalb, IL
  • NPI 1336151042
  Medicare reassignment Care Compare group NPD
• Northern Rehabilitation and Sports Medicine Associates

  • Physical Therapist
  • Rochelle, IL
  • NPI 1821267600
  NPD
• Northern Rehabilitation and Sports Medicine Associates

  • Physical Therapist
  • Genoa, IL
  • NPI 1831368612
  NPD (past)

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1811972805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3266 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-756-8524",
            "fax_number": "815-756-1841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3266 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-756-8524",
            "fax_number": "815-756-1841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE WAGNER",
        "first_name": "MELISSA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-13",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070013020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650023317",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "PAYNE",
            "middle_name": "S",
            "prefix": "MS.",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nimah Patoli, PHARMD
• Christa Patridge
• Talisa Marie Paul, MSW, CADC
• Theodore F Paul, D.C.
• Barbara L Paulson
• Jacob Tage Pearson, MS, LPC
• Nicolas Pedraza, P.T.
• Christine Marie Pelikan
• Frederick D Peltz, DDS
• Valerie Pena-Hernandez

• Physical Therapist in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; 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.