Individual provider Active NPI

Maxine M Lee, M.D.

  • Anesthesiology Physician
  • Roanoke, VA
National Provider Identifier
1538147814
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0101229173 Issued in VA
Practice address
5115 Bernard Dr Ste 201
Roanoke, VA 24018-4367
Phone
(540) 345-0289
Fax
(540) 345-9569
NPI assigned
Jan 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 0101229173 VA Primary

Addresses

Primary practice location

5115 Bernard Dr Ste 201
Roanoke, VA 24018-4367

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713

Other identifiers 2

IdentifierTypeStateIssuer
1538147814MedicaidWV
1538147814MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20040318000561 VA Practitioner - Anesthesiology 9830089366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Harvard Medical School, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Professional Services LLCGroup PAC ID 2163323999, 86 clinicians

Practice addresses (Care Compare)

101 Elm Ave SE
Roanoke, VA 24013-2222
Phone (540) 985-8000

180 Floyd Ave
Rocky Mount, VA 24151-1318
Phone (540) 489-6353

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 853-0222

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101229173VAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acv Inc Anesthesiology CurrentSince Jan 1, 2010 Accepting new patients
Carilion Professional Services LLC CurrentSince Oct 14, 2024 Accepting new patients
Anesthesiology Consultants of Virginia, Inc Anesthesiology PastSince Jan 1, 2010 Accepting new patients
Carilion Medical Center Past Accepting new patients

Locations

1102 S Jefferson St
Roanoke, VA 24016
Phone (540) 342-0707

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

5115 Bernard Dr
Ste 201
Roanoke, VA 24018
Phone (540) 345-0289

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

101 Elm Ave SE
Roanoke, VA 24013
Phone (540) 985-8000

180 Floyd Ave
Rocky Mount, VA 24151
Phone (540) 483-5277

Interoperability endpoints

  • Direct secure messaging: mlee1261@direct.carilionclinic.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1538147814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 BERNARD DR STE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184367",
            "telephone_number": "540-345-0289",
            "fax_number": "540-345-9569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MAXINE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101229173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538147814",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538147814",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.