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BLAINE PAYNE, INC
NPI 1770943409
Family Medicine - Geriatric Medicine in Madison, FL

Active since February 23, 2016CLIA 10D2110117 · Waiver
180 NW HAYNES ST, MADISON, FL 32340(850) 973-1215(866) 923-4163 Get Directions Write a Review

NPPES record last updated: June 30, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jun 30, 2016, Feb 23, 2016 (2 updates tracked since 2016).

About Blaine Payne, Inc NPPES

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

BLAINE PAYNE, INC (NPI 1770943409) is a healthcare organization registered as a geriatric medicine in Madison, Florida and active in the NPI registry since February 2016. The organization holds a CLIA Waiver certificate valid through March 8, 2028 and lists Tammey Revels, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1770943409
Entity TypeOrganization
Primary Taxonomy207QG0300X
Legal Business NameBLAINE PAYNE, INC
Location Address180 NW HAYNES STMadison, FL 32340-2010
Mailing AddressPo Box 185Madison, FL 32341-0185
Phone(850) 973-1215
Fax(866) 923-4163
Organization SubpartNo
Authorized OfficialTammey RevelsBusiness Manager · (850) 973-1215
Enumeration DateFebruary 23, 2016
Last NPPES UpdateJune 30, 20162 updates tracked since enumeration
✔ NPI 1770943409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QG0300X
License✔ Licensed in FL · OS9255
Definition
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
180 NW HAYNES ST, Madison, FL 32340
Open in Google Maps ↗

Other Identifiers 5

Medicaid272752800FL
OtherHUMANAHumana
OtherSXJQYBcbs
Medicare UPIN45245Z
Other37137Bcbs

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blaine Payne, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Blaine Payne, Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Theresa Payne, D.O.
Family Practice
NPI 1306858956
180 NW HAYNES ST
Madison, FL 32340
(850) 973-1215
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2110117

Blaine Payne Inc · Madison, FL
Active · expires Mar 8, 2028
CLIA Number10D2110117
Laboratory TypePhysician Office
Certificate Effective DateMarch 9, 2026
Certificate Expiration DateMarch 8, 2028
Laboratory DirectorTheresa Blaine Payne
Laboratory Phone(954) 882-8823
Laboratory LocationBlaine Payne Inc180 NW Haynes St, Madison, FL 32340
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Blaine Payne, Inc's NPI number?

The NPI number for Blaine Payne, Inc is 1770943409. It was assigned to this organization in the NPPES registry on February 23, 2016.

Where is Blaine Payne, Inc located?

Blaine Payne, Inc is located at 180 NW Haynes St, Madison, FL 32340. The listed phone number is (850) 973-1215.

What is Blaine Payne, Inc's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.

Is Blaine Payne, Inc enrolled in Medicare?

Yes. Blaine Payne, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Blaine Payne, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Blaine Payne, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Blaine Payne, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2110117) is associated with this NPI, valid through March 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Blaine Payne, Inc was last updated on June 30, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years 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.