Active NPI
Brian J Lee, MD
- Plastic Surgery Physician
- Fort Wayne, IN
National Provider Identifier
1508867656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 01040298A
- Practice address
- 7910 W Jefferson Blvd Ste 212
Fort Wayne, IN 46804-4159 - Phone
- (260) 427-7473
- Fax
- (260) 432-3189
- NPI assigned
- Aug 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 01040298A | IN | Primary |
Addresses
Primary practice location
7910 W Jefferson Blvd Ste 212
Fort Wayne, IN 46804-4159
Mailing address
7910 W Jefferson Blvd Ste 212
Fort Wayne, IN 46804-4159
Phone (260) 427-7473
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0984010 | Medicaid | OH | |
| 100372020 | Medicaid | IN | |
| 240007525 | Other | IN | MEDICARE RAILROAD |
| 104366796 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100119000448 | IN | Practitioner - Plastic and Reconstructive Surgery | 4688772932 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Plastic Surgery, PC | Plastic Surgery | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330992000000",
"number": "1508867656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7910 W JEFFERSON BLVD STE 212",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044159",
"telephone_number": "260-427-7473",
"fax_number": "260-432-3189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7910 W JEFFERSON BLVD STE 212",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044159",
"telephone_number": "260-427-7473",
"fax_number": "260-432-3189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "BRIAN",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2012-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "IN",
"license": "01040298A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0984010",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100372020",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "240007525",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104366796",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.