Individual provider Active NPI

Lee Thomas Hagenbaumer, CRNA

  • Certified Registered Nurse Anesthetist
  • Jacksonville, FL
National Provider Identifier
1548860711
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
11010755 Issued in FL
Practice address
3625 University Blvd S
Jacksonville, FL 32216-4207
Phone
(904) 702-6111
NPI assigned
Oct 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 11010755 FL Primary

Addresses

Primary practice location

3625 University Blvd S
Jacksonville, FL 32216-4207

Mailing address

9479 Heckscher Dr
Jacksonville, FL 32226-2420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210212000939 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729493358 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-6700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.8 of 100Reported as group
Quality
99.47
Improvement activities
40
Cost
83.62

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
11010755FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sunshine State Anesthesia Partners LLC CurrentSince Jun 1, 2021 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Current Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Jan 8, 2024 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Jan 8, 2024 Accepting new patients
US Anesthesia Partners of Florida Inc. Nurse Anesthetist, Certified Registered CurrentSince Jul 27, 2023 Accepting new patients

Locations

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

14000 Fivay Rd
Hudson, FL 34667
Phone (727) 819-2929

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

4016 Sun City Center Blvd
Sun City Ctr, FL 33573
Phone (813) 634-0145

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

9330 State Road 54
Trinity, FL 34655
Phone (727) 834-4000

Organizations & group practices 5

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 2

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": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1548860711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9479 HECKSCHER DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322262420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGENBAUMER",
        "first_name": "LEE",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-27",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "11010755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.