Active NPI
Michael James Lee, MD
- Gynecology Physician
- Portland, OR
National Provider Identifier
1164514204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- MD15362
- Practice address
- 9555 SW Barnes Rd
Suite 360
Portland, OR 97225-6663 - Phone
- (971) 254-8626
- Fax
- (503) 445-0597
- NPI assigned
- Sep 28, 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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | MD15362 | OR | Primary |
Addresses
Primary practice location
9555 SW Barnes Rd
Suite 360
Portland, OR 97225-6663
Mailing address
9555 SW Barnes Rd
Suite 360
Portland, OR 97225-6663
Phone (971) 254-8626
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 151910 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 26, 2017 through Nov 26, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15362 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484352000000",
"number": "1164514204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9555 SW BARNES RD",
"address_2": "SUITE 360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256663",
"telephone_number": "971-254-8626",
"fax_number": "503-445-0597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9555 SW BARNES RD",
"address_2": "SUITE 360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256663",
"telephone_number": "971-254-8626",
"fax_number": "503-445-0597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2017-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "OR",
"license": "MD15362",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151910",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2017; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.