NPIMap

Individual provider Active NPI

Samuel Jae Lee, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1548720279
Registry record updated Jun 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD482126 Issued in PA
Practice address
4417 N 6TH St
Philadelphia, PA 19140-2319
Phone
(215) 302-3600
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A177467 CA
Internal Medicine Physician 207R00000X MD482126 PA Primary

Addresses

Primary practice location

4417 N 6TH St
Philadelphia, PA 19140-2319

Mailing address

4417 N 6TH St
Philadelphia, PA 19140-2319
Phone (215) 302-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20230918001943 PA Practitioner - Internal Medicine 9537577077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Eastern Virginia Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esperanza Health Center, Inc.Group PAC ID 6103815071, 32 clinicians

Practice addresses (Care Compare)

2940 N 5TH St
Philadelphia, PA 19133-2801
Phone (215) 302-3600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A177467CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Esperanza Health Center, Inc. CurrentSince Aug 3, 2023 Accepting new patients
Esperanza Health Center, Inc. Past Accepting new patients
Temple University Hospital, Inc Past Accepting new patients

Locations

4417 N 6th St
Philadelphia, PA 19140
Phone (215) 302-3150

861 E Allegheny Ave
Philadelphia, PA 19134
Phone (215) 302-3600

2940 N 5th St
Philadelphia, PA 19133
Phone (215) 221-6633

Organizations & group practices 3

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 8

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1548720279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4417 N 6TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402319",
            "telephone_number": "215-302-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4417 N 6TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402319",
            "telephone_number": "215-302-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SAMUEL",
        "middle_name": "JAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A177467",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD482126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.