MRS. PAYTON RILEY O'TOOLE
NPI 1194395376
Nurse Practitioner - Family in Billings, MT

Active since June 29, 2021PECOS EnrolledAccepts Medicare Assignment
94.3/100
CMS Quality Rating
801 N 29TH ST, BILLINGS, MT 59101(406) 238-2500 Get Directions Write a Review

NPPES record last updated: December 27, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 27, 2024, Jun 29, 2021 (2 updates tracked since 2021).

About Mrs. Payton Riley O'toole NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. PAYTON RILEY O'TOOLE (NPI 1194395376) is an individual family provider in Billings, Montana, licensed in Montana (NUR-APRN-LIC-192850) and active in the NPI registry since June 2021. She is enrolled in Medicare PECOS, is affiliated with Billings Clinic, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1194395376
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. PAYTON RILEY O'TOOLE
Location Address801 N 29TH STBillings, MT 59101-0905
Mailing AddressPo Box 37000Billings, MT 59107-7000
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateJune 29, 2021
Last NPPES UpdateDecember 27, 20242 updates tracked since enumeration
NPPES CertifiedDecember 27, 2024
NPI 1194395376 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License Licensed in MT · NUR-APRN-LIC-192850
Also ListedRegistered Nurse · General PracticeTaxonomy 163WG0000X · License NUR-RN-LIC-192850 (MT), RN-84137 (NM)
Also ListedNeurological SurgeryTaxonomy 207T00000X · License NUR-APRN-LIC-192850 (MT)
801 N 29TH ST, Billings, MT 59101

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mrs. Payton Riley O'toole is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1052799004
PECOS Enrollment IDI20220602001503
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
37 services34 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
34 services29 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
23 services20 patients
Insertion of cage or mesh device to spine bone and disc space during spine fusion 22853
Spine fusion is a procedure to join two or more vertebrae. During this process, a cage or mesh device is inserted into the spine bone and disc space. This helps to stabilize the spine, reduce pain, and improve functionality. The device acts as a bridge for new bone to grow on.
21 services12 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
13 services13 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
12 services12 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Billings Clinic

Acute Care Hospitals · Billings, MT
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number270004
Location2800 10th Ave NBillings, MT 59101 · Yellowstone County
Emergency services Birthing friendly

Livingston Healthcare

Critical Access Hospitals · Livingston, MT
3/5 CMS rating
OwnershipPhysician
CMS Certification Number271317
Location320 Alpenglow LaneLivingston, MT 59047 · Park County
Emergency services

Beartooth Billings Clinic

Critical Access Hospitals · Red Lodge, MT
OwnershipVoluntary non-profit - Private
CMS Certification Number271326
Location2525 N BroadwayRed Lodge, MT 59068 · Carbon County

Sheridan Memorial Hospital

Acute Care Hospitals · Sheridan, WY
4/5 CMS rating
OwnershipGovernment - Local
CMS Certification Number530006
Location1401 W 5th StSheridan, WY 82801 · Sheridan County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 59101 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.97 typical visit price
range $56.81 – $172.26
Typical copayment $21.99 (range $14.20 – $43.06)
Most-billed visit code 99203
Established Patient
$100.16 typical visit price
range $18.24 – $140.32
Typical copayment $25.04 (range $4.56 – $35.08)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

94.3/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality85.58
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapist
801 N 29TH ST
BILLINGS, MT 59101
Physician Assistant (Surgical)
801 N 29TH ST
BILLINGS, MT 59101
Obstetrics & Gynecology (Gynecologic Oncology)
801 N 29TH ST
BILLINGS, MT 59101
Physician Assistant
801 N 29TH ST
BILLINGS, MT 59101
Occupational Therapist
801 N 29TH ST
BILLINGS, MT 59101
Ophthalmology
801 N 29TH ST
BILLINGS, MT 59101
Physician Assistant (Surgical)
801 N 29TH ST
BILLINGS, MT 59101
Family Medicine
801 N 29TH ST
BILLINGS, MT 59101

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Payton O'toole's NPI number?

The NPI number for Payton O'toole is 1194395376. It was assigned to this individual provider in the NPPES registry on June 29, 2021.

Where is Payton O'toole located?

Payton O'toole practices at 801 N 29th St, Billings, MT 59101. The listed phone number is (406) 238-2500.

What is Payton O'toole's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Payton O'toole enrolled in Medicare?

Yes. Payton O'toole is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Payton O'toole accept?

Health plans from Blue Cross and Blue Shield of Montana, Mountain Health CO-OP and Providence Health Plan list Payton O'toole as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Payton O'toole affiliated with any hospitals?

According to CMS data, Payton O'toole is affiliated with Billings Clinic, Livingston Healthcare, Beartooth Billings Clinic and Sheridan Memorial Hospital.

When was this NPI record last updated?

The NPPES record for Payton O'toole was last updated on December 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.