Active NPI
Theodore Lee, MD
- Diagnostic Radiology Physician
- Louisville, KY
National Provider Identifier
1043218308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 24996
- Practice address
- 200 E Chestnut St
Louisville, KY 40202-1831 - Phone
- (502) 629-7601
- NPI assigned
- Jul 11, 2005
- Last updated
- Feb 27, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 24996 | KY | Primary |
Addresses
Primary practice location
200 E Chestnut St
Louisville, KY 40202-1831
Mailing address
234 E Gray St
Suite 850
Louisville, KY 40202-1900
Phone (502) 629-7601
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000050043 | Other | KY | BC BS |
| 64249964 | Medicaid | KY | |
| 000000308613 | Other | KY | BC BS |
| 50005987 | Other | KY | PASSPORT |
| 1051833 | Other | KY | PASSPORT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kentuckiana Diagnostics | Diagnostic Radiology | Past | Accepting new patients |
| KD Imaging LLC | Past | Accepting new patients | |
| Open MRI, LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Kentuckiana Diagnostics
- Clinical Medical Laboratory
- Jeffersonville, IN
- NPI 1497780753
-
- Diagnostic Radiology Physician
- Jeffersonville, IN
- NPI 1225030901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1043218308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "234 E GRAY ST",
"address_2": "SUITE 850",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021900",
"telephone_number": "502-629-7601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E CHESTNUT ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021831",
"telephone_number": "502-629-7601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "THEODORE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-11",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "KY",
"license": "24996",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "000000050043",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64249964",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "000000308613",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT",
"identifier": "50005987",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT",
"identifier": "1051833",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.