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SONJA PAULEY
NPI 1912583949
Nurse Practitioner - Psychiatric/Mental Health in Sidney, OH

Active since March 21, 2021PECOS EnrolledAccepts Medicare Assignment
94.42/100
CMS Quality Rating
21151 TAWAWA ST, SIDNEY, OH 45365(619) 616-0107 Get Directions Write a Review

NPPES record last updated: July 1, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 1, 2021, Mar 21, 2021 (2 updates tracked since 2021).

About Sonja Pauley NPPES

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

SONJA PAULEY (NPI 1912583949) is an individual psychiatric/mental health provider in Sidney, Ohio, licensed in Ohio (0029164CNP) and active in the NPI registry since March 2021. She is enrolled in Medicare PECOS and is a graduate of Wright State University Boonshoft School Of Medicine (2021).

NPPES Registry Identity

NPI1912583949
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameSONJA PAULEY
Location Address21151 TAWAWA STSidney, OH 45365-6713
Mailing Address21151 Tawawa StSidney, OH 45365-6713
Phone(619) 616-0107
Sole ProprietorYes
Medical School CMSWright State University Boonshoft School Of MedicineGraduated 2021
Enumeration DateMarch 21, 2021
Last NPPES UpdateJuly 1, 20212 updates tracked since enumeration
NPPES CertifiedJuly 1, 2021
✔ NPI 1912583949 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in OH · 0029164CNP
Also ListedRegistered NurseTaxonomy 163W00000X · License RN.311874 (OH)
21151 TAWAWA ST, Sidney, OH 45365
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, MedMutual and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sonja Pauley 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 ID941602023
PECOS Enrollment IDI20210712003934
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.

Medicare Billing Reassignment

Medicare enrollment records show Sonja Pauley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Alcove Ventures LLC
147 mi
Psychiatric/Mental Health
10603 DETROIT AVE
Cleveland, OH 44102
  • Reassigned Medicare billing, Ohio enrollment
  • 100 clinicians in this Medicare group
NPI 1093191322 (844) 291-4535

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

Areas of Expertise CMS Part B claims 9

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.

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
1,811 services303 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
421 services146 patients
Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349
An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.
168 services39 patients
Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional 99484
Care management for behavioral health involves a healthcare professional directing clinical staff to provide you with support for 20 minutes or more. This service can include planning your care, coordinating services, and managing your health conditions to improve your overall well-being.
149 services86 patients
Administration and interpretation of patient-focused health risk assessment 96160
This procedure involves a detailed evaluation of your health to identify potential risks. It includes analyzing your medical history, lifestyle habits, and family health history. The results are interpreted to provide a personalized plan to improve your health and prevent future issues.
116 services114 patients
Psychiatric diagnostic evaluation with medical services 90792
A psychiatric diagnostic evaluation with medical services is a comprehensive assessment. It includes a detailed examination of your mental health and physical wellbeing, as well as your personal and family history. This evaluation aids in creating an effective treatment plan.
110 services110 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45365 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
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

94.42/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality94.28
Improvement Activities40
Cost58.55

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 Sonja Pauley's NPI number?

The NPI number for Sonja Pauley is 1912583949. It was assigned to this individual provider in the NPPES registry on March 21, 2021.

Where is Sonja Pauley located?

Sonja Pauley practices at 21151 Tawawa St, Sidney, OH 45365. The listed phone number is (619) 616-0107.

What is Sonja Pauley's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Sonja Pauley enrolled in Medicare?

Yes. Sonja Pauley 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.

Which organization bills Medicare for Sonja Pauley's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sonja Pauley reassigns Medicare benefits to Alcove Ventures LLC (Cleveland, OH). The 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 Sonja Pauley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sonja Pauley accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, MedMutual, Molina Healthcare and Oscar Health Insurance and 2 other insurers list Sonja Pauley 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.

When was this NPI record last updated?

The NPPES record for Sonja Pauley was last updated on July 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.