Individual provider Active NPI

Alice Lee, DO

  • Vascular Surgery Physician
  • Detroit, MI
National Provider Identifier
1366707739
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
5101024392 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(800) 653-6568
NPI assigned
Jul 11, 2012
Last updated
Feb 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NONE NJ
Vascular Surgery Physician 2086S0129X 5101024392 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

6466 Emerald Dunes Drive
207
West Palm Beach, FL 33411

Other practice location 1

7600 River Rd
North Bergen, NJ 07047-6217
Phone (201) 854-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alee545830@direct.hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20181010002310 MI Practitioner - Vascular Surgery 5092067546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)13
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NONENJMDSurgery Physician
5101024392MIMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System Surgery CurrentSince Sep 20, 2018 Accepting new patients
Henry Ford Health System CurrentSince Sep 20, 2018 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

19401 Hubbard Dr
Dearborn, MI 48126
Phone (313) 982-8100

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

2799 W Grand Blvd
#363
Detroit, MI 48202
Phone (313) 916-2020

2799 W Grand Blvd
#K8
Detroit, MI 48202
Phone (313) 916-1755

2799 W Grand Blvd
Bsmt
Detroit, MI 48202
Phone (313) 916-1128

Organizations & group practices 4

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 2

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": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1366707739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6466 EMERALD DUNES DRIVE",
            "address_2": "207",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "800-653-6568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7600 River Rd",
            "address_purpose": "LOCATION",
            "city": "North Bergen",
            "state": "NJ",
            "postal_code": "070476217",
            "country_code": "US",
            "telephone_number": "201-854-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "ALICE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "NONE",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "5101024392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alee545830@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.