Individual provider Active NPI

Eugene Lee, M.D.

  • Surgery Physician
  • McHenry, IL
National Provider Identifier
1306835244
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036065069 Issued in IL
Practice address
4309 W Medical Center Dr Ste B202
McHenry, IL 60050-8417
Phone
(815) 455-2752
Fax
(815) 455-2789
NPI assigned
Oct 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036065069 IL Primary

Addresses

Primary practice location

4309 W Medical Center Dr Ste B202
McHenry, IL 60050-8417

Mailing address

4309 W Medical Center Dr Ste B202
McHenry, IL 60050-8417
Phone (815) 455-2752

Other practice location 1

360 N Terra Cotta Rd Ste C
Crystal Lake, IL 60012-3749
Phone (815) 455-2752

Other practice location 2

10350 Haligus Rd Ste 200A
Huntley, IL 60142-9585
Phone (815) 455-2752

Other practice location 3

3707 Doty Rd Ste E
Woodstock, IL 60098-7530
Phone (815) 455-2752

Other identifiers 2

IdentifierTypeStateIssuer
036065069OtherILSTATE LICENSE
036065069MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040504000642 IL Practitioner - General Surgery 9335137868 Reassigns benefits to 1 organization

National Provider Directory

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

Organizations & group practices 1

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1306835244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B202",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508417",
            "telephone_number": "815-455-2752",
            "fax_number": "815-455-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B202",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508417",
            "telephone_number": "815-455-2752",
            "fax_number": "815-455-2789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 N Terra Cotta Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600123749",
            "country_code": "US",
            "telephone_number": "815-455-2752",
            "fax_number": "815-455-2789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10350 Haligus Rd Ste 200A",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429585",
            "country_code": "US",
            "telephone_number": "815-455-2752",
            "fax_number": "815-455-2789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3707 Doty Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987530",
            "country_code": "US",
            "telephone_number": "815-455-2752",
            "fax_number": "815-455-2789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "EUGENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036065069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036065069",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036065069",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.