Seong Gon Bae, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME128524 Issued in FL

Practice address

4106 W Lake Mary Blvd Ste 330
Lake Mary, FL 32746-3383

Phone

(407) 833-9195

NPI assigned

Jun 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Samuel Bae Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, FL2 enrollments

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 2

Specialty

General Surgery

Education

University of South Florida College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thomas J Lomis M D Inc a Professional CorporationGroup PAC ID 9739145806, 12 clinicians

Southern California Multi-Specialty Center IncGroup PAC ID 4082953336, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Holy Cross Medical Center Hospital, Mission Hills, CA, CCN 050278
• Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235
• Providence Cedars Sinai Tarzana Medical Center Hospital, Tarzana, CA, CCN 050761

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: sbae766421@adventhealth.direct-ci.com

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.

• Southern California Multi-Specialty Center Inc

  • Surgery Physician
  • Sherman Oaks, CA
  • NPI 1407326606
  Medicare reassignment Care Compare group NPD
• Thomas J Lomis, MD, Inc. a Professional Corporation

  • Surgical Oncology Physician
  • Van Nuys, CA
  • NPI 1982700035
  Medicare reassignment Care Compare group NPD
• Florida Hospital Medical Group Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Surgery

  Medicare reassignment NPD
• Florida Hospital Medical Group Inc

  dba Rothman Orthopaedics AdventHealth Medical Group at Minneola

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD
• Southern California Multi-Specialty Center Inc

  • Surgery Physician
  • Tarzana, CA
  • NPI 1730863804
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health System - Southern California

  dba Providence Saint Joseph Medical Center

  • General Acute Care Hospital
  • Burbank, CA
  • NPI 1336173269
  Care Compare affiliation
• Providence Health System - Southern California

  dba Providence Holy Cross Medical Center

  • General Acute Care Hospital
  • Mission Hills, CA
  • NPI 1477587632
  Care Compare affiliation
• Tarzana Medical Center LLC

  dba Providence Cedars-Sinai Tarzana Medical Center

  • General Acute Care Hospital
  • Tarzana, CA
  • NPI 1821250762
  Care Compare affiliation

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1114122769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD STE 330",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463383",
            "telephone_number": "407-833-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD STE 330",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463383",
            "telephone_number": "407-833-9195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15211 Vanowen St Unit 200",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914053606",
            "country_code": "US",
            "telephone_number": "818-782-3255",
            "fax_number": "818-782-7026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAE",
        "first_name": "SEONG",
        "middle_name": "GON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-15",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A123341",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME128524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SAMUEL",
            "last_name": "BAE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Maria Aziz
• Mena Aziz
• Jesica L Aznar, MA
• B Rai Gupta MD PA (Fl Center for Plastic & Hand Surgery)
• Kara Meg Bachus, O.D. , F.A.A.O.
• Emaya Bailey
• Erin Bailey, PHARMD
• Sandra C Bailey
• Daisy Bajwa
• Katherine Miner Baker, OTD, OT/L

• Surgery Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.