Southlake Endocrinology, PLLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

SOUTHLAKE ENDOCRINOLOGY, PLLC

Practice address

1202 S. Whilte Chapel Blvd
Southlake, TX 76092-3422

Phone

(707) 235-7166

NPI assigned

Jan 18, 2022

Last updated

Mar 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

DO-Eun Lee, MDNPI 1346339652

Title

Owner

Phone

(707) 235-7166

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26461/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• DO-Eun Lee, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Napa, CA
  • NPI 1346339652

  TX

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1558012997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 PLANTATION DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760923422",
            "telephone_number": "707-235-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 S. WHILTE CHAPEL BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760923422",
            "telephone_number": "707-235-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE ENDOCRINOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-18",
        "last_updated": "2022-03-01",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "DO-EUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-235-7166",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endocrinology, Diabetes & Metabolism Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Endocrinology, Diabetes & Metabolism Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.