Active NPI
Gordon Eliot Lee, MD
- Gastroenterology Physician
- Santa Cruz, CA
National Provider Identifier
1124100367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- G29794
- Practice address
- 1505 Soquel Drive
Suite 8
Santa Cruz, CA 95065-1716 - Phone
- (831) 476-4230
- Fax
- (831) 476-0571
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | G29794 | CA | Primary |
Addresses
Primary practice location
1505 Soquel Drive
Suite 8
Santa Cruz, CA 95065-1716
Mailing address
1505 Soquel Drive
Suite 8
Santa Cruz, CA 95065-1716
Phone (831) 476-4230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4087118 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101027000204 | CA | Practitioner - Gastroenterology | 2860555646 | Practice locations: Santa Cruz, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G29794 | CA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327363200000",
"number": "1124100367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 SOQUEL DRIVE",
"address_2": "SUITE 8",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950651716",
"telephone_number": "831-476-4230",
"fax_number": "831-476-0571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 SOQUEL DRIVE",
"address_2": "SUITE 8",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950651716",
"telephone_number": "831-476-4230",
"fax_number": "831-476-0571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "GORDON",
"middle_name": "ELIOT",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2012-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "CA",
"license": "G29794",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4087118",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.