Jaewon Lee, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

66164 Issued in NM

Practice address

1217 Bonita St
Grants, NM 87020-2103

Phone

(052) 872-9585

Fax

(505) 443-8342

NPI assigned

Aug 8, 2016

Last updated

Jan 15, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jae Won Lee Former name

Medicare fee-for-service enrollment

Enrolled in TX, NM2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Presbyterian Medical ServicesGroup PAC ID 2062324684, 132 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cibola General Hospital Hospital, Grants, NM, CCN 321308

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jaewon.lee.p1@direct.pmsnm.nextgenshare.com

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.

• Presbyterian Medical Services

  dba Rio Rancho Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Rio Rancho, NM
  • NPI 1871505032
  Medicare reassignment Care Compare group NPD
• DHHS PHS Naihs Crownpoint Hospital

  • General Acute Care Hospital
  • Crownpoint, NM
  • NPI 1114960093

  TX

  Medicare reassignment NPD
• Presbyterian Medical Services

  dba PMS Central Pharmacy

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1306654462
  NPD
• Presbyterian Medical Services

  dba Carlsbad Family Health Center Behavioral Health

  • Clinic/Center
  • Carlsbad, NM
  • NPI 1629468830
  NPD
• Pueblo Pintado Clinic

  • Clinic/Center
  • Cuba, NM
  • NPI 1023051133
  NPD
• Thoreau Clinic

  • Clinic/Center
  • Thoreau, NM
  • NPI 1679516702
  NPD
• Presbyterian Medical Services

  • Federally Qualified Health Center (FQHC)
  • Santa Fe, NM
  • NPI 1518910553
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cibola General Hospital Corporation

  dba Cibola General Hospital

  • Critical Access Hospital
  • Grants, NM
  • NPI 1780677039
  Care Compare affiliation

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1558815522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 BONITA ST",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870202103",
            "telephone_number": "052-872-9585",
            "fax_number": "505-443-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 BONITA ST",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870202103",
            "telephone_number": "052-872-9585",
            "fax_number": "505-443-8342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 US Highway 66 E",
            "address_purpose": "LOCATION",
            "city": "Tell City",
            "state": "IN",
            "postal_code": "475862755",
            "country_code": "US",
            "telephone_number": "812-547-3447",
            "fax_number": "812-547-9543",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 US Highway 66 E",
            "address_purpose": "LOCATION",
            "city": "Tell City",
            "state": "IN",
            "postal_code": "475862755",
            "country_code": "US",
            "telephone_number": "812-547-3447",
            "fax_number": "812-547-9543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "JAEWON",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-08",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "5905",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "F07161203",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "66164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAE WON",
            "last_name": "LEE",
            "credential": "CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janelle Lamb, LMSW
• Elise Ann Larsen, LCSW
• Las Brisas Enterprises, LLC (A to Z Childrens Dentistry)
• Elizabeth A Laurent, LMT
• Jonathon Michael Lavalley, PA-C
• Legacy 4 Health Solutions, LLC
• Legacy Nursing Services LLC
• Rodney Alan Lente
• Melissa A Leyba, LMSW
• John Gerard Lillo, PA

• Family Nurse Practitioner in Grants, NM
• Providers in Grants, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.