NPIMap

Individual provider Active NPI

Kerry Todd Lee, M.D.

  • Family Medicine Physician
  • Grenada, MS
National Provider Identifier
1467470799
Registry record updated Jun 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12517 Issued in MS
Practice address
1300 Sunset Dr
Suite F
Grenada, MS 38901-4086
Phone
(662) 226-5747
Fax
(662) 226-5622
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2010

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 12517 MS Primary

Addresses

Primary practice location

1300 Sunset Dr
Suite F
Grenada, MS 38901-4086

Mailing address

1300 Sunset Dr
Suite F
Grenada, MS 38901-4086
Phone (662) 226-5747

Other identifiers 7

IdentifierTypeStateIssuer
080175512OtherMSRAILROAD MEDICARE
CH9466OtherMSRAILROAD MEDICARE GROUP
09014826MedicaidMS
09013778MedicaidMS
1700994738OtherMSPECOS
640835695OtherMSBC/BS OF MISSISSIPPI
0112670MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120203000499 MS Practitioner - Family Practice 9032161955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Mississippi - University of Mississippi Medical CenterGroup PAC ID 1850293036, 956 clinicians

Practice addresses (Care Compare)

418 BN Applegate St
Ummc Grenada Family Medicine Clinic
Winona, MS 38967-1827
Phone (662) 283-4533

960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7000

965 Avent Dr
Grenada, MS 38901-5045
Phone (662) 227-7444

Hospital & facility affiliations

  • Vitalcaring Group Home health agency, Cleveland, MS, CCN 257016
  • Accentcare Home Health of Greenwood Home health agency, Greenwood, MS, CCN 257131
  • Adoration Home Health Care Mississippi Home health agency, Cleveland, MS, CCN 257305
  • University of Mississippi Medical Center- Grenada Hospital, Grenada, MS, CCN 250168
  • Tyler Holmes Memorial Hospital Cah Hospital, Winona, MS, CCN 251312

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Sep 1, 2015 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi-University of Mississippi Medical Center Family Medicine CurrentSince Sep 1, 2015 Accepting new patients
Grenada Family Medicine Clinic Family Medicine Current Accepting new patients
University Physicians, PLLC Past Accepting new patients

Locations

965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000

1300 Sunset Dr
Ste F
Grenada, MS 38901
Phone (662) 226-5747

418 N Applegate St
#B
Winona, MS 38967
Phone (662) 283-4433

418B N Applegate St
Winona, MS 38967
Phone (662) 283-4433

Interoperability endpoints

  • Direct secure messaging: klee64164@ummc.direct-ci.com

Organizations & group practices 26

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.

View all 26

Hospital & facility affiliations 6

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1467470799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 SUNSET DR",
            "address_2": "SUITE F",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014086",
            "telephone_number": "662-226-5747",
            "fax_number": "662-226-5622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SUNSET DR",
            "address_2": "SUITE F",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014086",
            "telephone_number": "662-226-5747",
            "fax_number": "662-226-5622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KERRY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "12517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080175512",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CH9466",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014826",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013778",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PECOS",
            "identifier": "1700994738",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MISSISSIPPI",
            "identifier": "640835695",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112670",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grenada, MS

Sources for this page

Verify at the official NPI Registry.