Individual provider Active NPI

Suzette Lee

  • Foot & Ankle Surgery Podiatrist
  • Los Angeles, CA
National Provider Identifier
1255457495
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E3580 Issued in CA
Practice address
6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone
(323) 857-2000
NPI assigned
Mar 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X E3580 CA Primary

Addresses

Primary practice location

6041 Cadillac Ave
Los Angeles, CA 90034-1702

Mailing address

6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone (323) 857-2000

Other names 1

  • Suzette Lee Shults Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050118000166 CA Practitioner - Podiatry 9234188244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12001 W Washington Blvd
Los Angeles, CA 90066-5801
Phone (310) 915-4410

393 E Walnut St
Pasaden, CA 91188-0001
Phone (877) 608-0044

393 E Walnut St 3Rd FL
Pasadena, CA 91188-0001

6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone (800) 954-8000

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E3580CAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jul 21, 2019 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

Organizations & group practices 2

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": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1255457495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6041 CADILLAC AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900341702",
            "telephone_number": "323-857-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6041 CADILLAC AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900341702",
            "telephone_number": "323-857-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SUZETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E3580",
            "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": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUZETTE",
            "last_name": "LEE SHULTS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.