Individual provider Active NPI

Eugene S Lee, M.D., PH.D.

  • Vascular Surgery Physician
  • Twin Falls, ID
National Provider Identifier
1518943265
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
M-16547 Issued in ID
Practice address
775 Pole Line Rd W Ste 213
Twin Falls, ID 83301-5820
Phone
(208) 814-8953
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X A78144 CA
Vascular Surgery Physician 2086S0129X M-16547 ID Primary
Vascular Surgery Physician 2086S0129X 18532 ND
Surgery Physician 208600000X MD60676859 WA
Vascular Surgery Physician 2086S0129X MD60676859 WA

Addresses

Primary practice location

775 Pole Line Rd W Ste 213
Twin Falls, ID 83301-5820

Mailing address

190 E Bannock St # 112
Boise, ID 83712-6241

Other practice location 1

2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 857-5000

Other practice location 2

101 3rd Ave SW
Minot, ND 58701-3880
Phone (701) 857-5764

Other practice location 3

1100 Goethals Dr Ste E
Richland, WA 99352-3301
Phone (509) 942-3095

Other practice location 4

10535 Hospital Way
Sac 112
Mather, CA 95655-4200
Phone (916) 843-7202

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, ID, ND3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20040715001334 CA Practitioner - Vascular Surgery 4789663444 Reassigns benefits to 1 organization
I20220801000409 ID Practitioner - Vascular Surgery 4789663444
I20220913002571 ND Practitioner - Vascular SurgeryPractitioner - General Surgery 4789663444 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Tufts University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2401 Demers Ave
Grand Forks, ND 58201-4183

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
78144CAMDPharmacist
A78144CAMDVascular Surgery Physician
M-16547IDMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health CurrentSince Nov 22, 2022 Accepting new patients
Trinity Health Current Accepting new patients
Kern County Hospital Authority CurrentSince Mar 1, 2022 Accepting new patients
Kern County Hospital Authority CurrentSince Mar 1, 2022 Accepting new patients
Altru Health System Surgery CurrentSince Jul 14, 2022 Accepting new patients
Trinity Health CurrentSince Nov 22, 2022 Accepting new patients
Altru Health System CurrentSince Jul 14, 2022 Accepting new patients

Locations

3551 Q St
Bakersfield, CA 93301
Phone (661) 862-8262

1700 Mount Vernon Ave
Bakersfield, CA 93306
Phone (616) 326-2000

2720 Dundee Rd
Northbrook, IL 60062
Phone (224) 226-5222

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

101 3rd Ave SW
Minot, ND 58701
Phone (701) 857-5286

2305 37th Ave SW
Minot, ND 58701
Phone (701) 418-8550

Organizations & group practices 7

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 7

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1518943265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST # 112",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 213",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015820",
            "telephone_number": "208-814-8953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 3rd Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587013880",
            "country_code": "US",
            "telephone_number": "701-857-5764",
            "fax_number": "701-857-3557",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Goethals Dr Ste E",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993523301",
            "country_code": "US",
            "telephone_number": "509-942-3095",
            "fax_number": "509-942-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10535 Hospital Way",
            "address_2": "SAC 112",
            "address_purpose": "LOCATION",
            "city": "Mather",
            "state": "CA",
            "postal_code": "956554200",
            "country_code": "US",
            "telephone_number": "916-843-7202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "EUGENE",
        "middle_name": "S",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A78144",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ID",
            "license": "M-16547",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ND",
            "license": "18532",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60676859",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD60676859",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.