Individual provider Active NPI

Jennifer Tung Lee, MD

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1447288204
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A89100 Issued in CA
Practice address
3536 Mendocino Avenue
Suite 300
Santa Rosa, CA 95403
Phone
(707) 571-1280
Fax
(707) 578-5849
NPI assigned
Jun 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A89100 CA Primary

Addresses

Primary practice location

3536 Mendocino Avenue
Suite 300
Santa Rosa, CA 95403

Mailing address

15620 Healdsburg Avenue
Healdsburg, CA 95448
Phone (707) 473-4531

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061215000529 CA Practitioner - Family Practice 9133128390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

3883 Airway Dr
Suite 202
Santa Rosa, CA 95403-1671
Phone (707) 521-7777

Hospital & facility affiliations

  • Sutter Care at Home Home health agency, Santa Rosa, CA, CCN 058189

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Sutter East Bay Medical Foundation Family Medicine Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

795 El Camino Real
#1112
Palo Alto, CA 94301

6000 State Farm Dr
Ste 150
Rohnert Park, CA 94928
Phone (707) 559-7600

3325 Chanate Rd
Santa Rosa, CA 95404
Phone (707) 576-4000

3536 Mendocino Ave
Ste 300
Santa Rosa, CA 95403
Phone (707) 524-7301

2455 Summerfield Rd
Santa Rosa, CA 95405
Phone (707) 308-2815

3883 Airway Dr
Ste 202
Santa Rosa, CA 95403
Phone (707) 521-7777

4700 Hoen Ave
Santa Rosa, CA 95405
Phone (707) 526-3360

131 Stony Cir
Ste 1600
Santa Rosa, CA 95401
Phone (707) 541-7700

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

Interoperability endpoints

  • Direct secure messaging: jlee35879@hisp.ehr.sutterhealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1447288204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15620 HEALDSBURG AVENUE",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "95448",
            "telephone_number": "707-473-4531",
            "fax_number": "707-473-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVENUE",
            "address_2": "SUITE 300",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95403",
            "telephone_number": "707-571-1280",
            "fax_number": "707-578-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JENNIFER",
        "middle_name": "TUNG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A89100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.