Individual provider Active NPI

David Ryan Payne, APRN-CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Ft Mitchell, KY
National Provider Identifier
1992488548
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4018618 Issued in KY
Practice address
250 Grandview Dr Ste 575
Fort Mitchell, KY 41017-5641
Phone
(859) 486-2810
NPI assigned
Aug 10, 2023
Last updated
Jun 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1015119 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4018618 KY Primary

Addresses

Primary practice location

250 Grandview Dr Ste 575
Fort Mitchell, KY 41017-5641

Mailing address

250 Grandview Dr Ste 575
Fort Mitchell, KY 41017-5641
Phone (859) 486-2810

Other practice location 1

3200 Vine St
Cincinnati, OH 45220-2213
Phone (513) 861-3100

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240916002780 KY Practitioner - Nurse Practitioner 6800337064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

250 Grandview Dr
Suite 575
Ft Mitchell, KY 41017-5641
Phone (859) 486-2808

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4018618KYMDPsychiatric/Mental Health Nurse Practitioner
1015119TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological & Behavioral Consultants, LLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

250 Grandview Dr
Ste 575
Ft Mitchell, KY 41017
Phone (317) 292-7108

100 Executive Park
Ste 103
Louisville, KY 40207
Phone (502) 552-5068

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.davidpayne@140097.advancedmd-direct.com

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": "1691625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1992488548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 GRANDVIEW DR STE 575",
            "city": "FORT MITCHELL",
            "state": "KY",
            "postal_code": "410175641",
            "telephone_number": "859-486-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 GRANDVIEW DR STE 575",
            "city": "FORT MITCHELL",
            "state": "KY",
            "postal_code": "410175641",
            "telephone_number": "859-486-2810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Vine St",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452202213",
            "country_code": "US",
            "telephone_number": "513-861-3100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "DAVID",
        "middle_name": "RYAN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-10",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1015119",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4018618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Mitchell, KY

Sources for this page

Verify at the official NPI Registry.