Individual provider Active NPI

Walter Korea Lee, M.D.

  • Child & Adolescent Psychiatry Physician
  • Highlands Ranch, CO
National Provider Identifier
1104142793
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
DR.0052094 Issued in CO
Practice address
9139 Ridgeline Blvd
Highlands Ranch, CO 80129-2333
Phone
(303) 338-4545
NPI assigned
Apr 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X DR.0052094 CO Primary

Addresses

Primary practice location

9139 Ridgeline Blvd
Highlands Ranch, CO 80129-2333

Mailing address

10350 E Dakota Ave
Denver, CO 80247-1314

Other identifiers 2

IdentifierTypeStateIssuer
24273741MedicaidCO
028912OtherCOKAISER COMMERCIAL NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150908001374 CO Practitioner - PsychiatryPractitioner - Pediatric Medicine 4486960382 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0052094COMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Permanente Medical Group, P.C. CurrentSince Jul 23, 2018 Accepting new patients

Locations

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

10350 E Dakota Ave
Denver, CO 80247
Phone (303) 636-3350

9139 Ridgeline Blvd
Highlands Ranch, CO 80129
Phone (303) 471-7700

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1104142793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802471314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9139 RIDGELINE BLVD",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292333",
            "telephone_number": "303-338-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "WALTER",
        "middle_name": "KOREA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-08",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CO",
            "license": "DR.0052094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24273741",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "028912",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "CAREQUALITY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9139 Ridgeline Blvd",
            "city": "Highlands Ranch",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801292333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Highlands Ranch, CO

Sources for this page

Verify at the official NPI Registry.