Individual provider Active NPI

Andrew John Lee, MD

  • Internal Medicine Physician
  • Crestline, OH
National Provider Identifier
1285611657
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35.068404 Issued in OH
Practice address
385 N Seltzer St
Suite 3
Crestline, OH 44827-1400
Phone
(419) 468-0449
Fax
(419) 468-0634
NPI assigned
Dec 28, 2005
Last updated
Jan 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 68404 OH
Pediatrics Physician 208000000X 35.068404 OH
Internal Medicine Physician 207R00000X 35.068404 OH Primary

Addresses

Primary practice location

385 N Seltzer St
Suite 3
Crestline, OH 44827-1400

Mailing address

385 N Seltzer St
Suite3
Crestline, OH 44827-1400
Phone (419) 468-0449

Other identifiers 1

IdentifierTypeStateIssuer
0159135MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alee490008@direct.osumc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050713000888 OH Practitioner - Internal Medicine 5890721542 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Texas Medical Branch at Galveston, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Central Ohio Family Care Center IncGroup PAC ID 3274437082, 194 clinicians
Galion Community HospitalGroup PAC ID 5496737439, 40 clinicians

Practice addresses (Care Compare)

2981 W 4TH St
Ontario, OH 44906-1267
Phone (419) 468-0505

330 N Seltzer St
Crestline, OH 44827-1403
Phone (419) 468-0505

385 N Seltzer St
Crestline, OH 44827-1400
Phone (419) 468-0449

700 N Columbus St
Crestline, OH 44827-1455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.068404OHMDInternal Medicine Physician
68404OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Galion Community Hospital Internal Medicine CurrentSince Jul 1, 2005 Accepting new patients
Galion Community Hospital CurrentSince Jul 1, 2005 Accepting new patients

Locations

385 N Seltzer St
Crestline, OH 44827
Phone (419) 468-0449

385 N Seltzer St
Unit 3
Crestline, OH 44827
Phone (419) 468-0449

700 N Columbus St
Crestline, OH 44827
Phone (419) 462-3485

269 Portland Way S
Galion, OH 44833
Phone (419) 462-4547

2981 W 4th St
Ontario, OH 44906
Phone (419) 468-0505

Interoperability endpoints

  • Direct secure messaging: alee490008@direct.osumc.edu

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1285611657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 N SELTZER ST",
            "address_2": "SUITE3",
            "city": "CRESTLINE",
            "state": "OH",
            "postal_code": "448271400",
            "telephone_number": "419-468-0449",
            "fax_number": "419-468-0634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 N SELTZER ST",
            "address_2": "SUITE 3",
            "city": "CRESTLINE",
            "state": "OH",
            "postal_code": "448271400",
            "telephone_number": "419-468-0449",
            "fax_number": "419-468-0634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "68404",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.068404",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.068404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159135",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alee490008@direct.osumc.edu",
            "affiliation": "N",
            "address_1": "385 N Seltzer St",
            "address_2": "Suite 3",
            "city": "Crestline",
            "state": "OH",
            "country_code": "US",
            "postal_code": "448271400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crestline, OH

Sources for this page

Verify at the official NPI Registry.