NPIMap

Organization Active NPI

Bay Ridge Medical Group, PLLC

  • Interventional Cardiology Physician
  • Brooklyn, NY
National Provider Identifier
1245097989
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
BAY RIDGE MEDICAL GROUP, PLLC
Practice address
7404 5TH Ave
Brooklyn, NY 11209-2704
Phone
(929) 415-8856
Fax
(718) 233-3165
NPI assigned
Feb 29, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Dr. John Hyung Il Lee, MDNPI 1154502045
Title
Owner
Phone
(929) 415-8856

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X Primary
Nuclear Cardiology Physician 207UN0901X

Addresses

Primary practice location

7404 5TH Ave
Brooklyn, NY 11209-2704

Mailing address

7404 5TH Ave
Brooklyn, NY 11209-2704
Phone (929) 415-8856

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240320002001 NY Part B Supplier - Clinic/Group Practice 0244677789 Receives reassigned benefits from 11 practitioners
Practice locations: Brooklyn, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2304226Bay Ridge Medical Group PLLC7404 5TH Ave, Ste 1, Brooklyn, NY 11209RegistrationJul 31, 2026

National Provider Directory

National Provider Directory

Locations

1722 Pitkin Ave
Brooklyn, NY 11212
Phone (929) 415-8856

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1245097989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7404 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112092704",
            "telephone_number": "929-415-8856",
            "fax_number": "718-233-3165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7404 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112092704",
            "telephone_number": "929-415-8856",
            "fax_number": "718-233-3165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY RIDGE MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HYUNG IL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "929-415-8856",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.