Individual provider Active NPI

Michael Dominic Lee, M.D.

  • Dermatology Physician
  • Fort Myers, FL
National Provider Identifier
1639403462
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME116210 Issued in FL
Practice address
7331 Gladiolus Drive
Fort Myers, FL 33908
Phone
(239) 437-8810
Fax
(239) 437-8875
NPI assigned
Sep 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MT194482 PA
Dermatology Physician 207N00000X ME116210 FL Primary

Addresses

Primary practice location

7331 Gladiolus Drive
Fort Myers, FL 33908

Mailing address

15051 S. Tamiami Trail
Suite 203
Fort Myers, FL 33908
Phone (239) 437-8810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20140609002444 FL Practitioner - Dermatology 7719101922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Jefferson Medical College of Thomas Jefferson University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

1015 Crosspointe Dr
Naples, FL 34110-0949
Phone (239) 596-9075

9400 Gladiolus Dr
Suite 320
Fort Myers, FL 33908-9622
Phone (239) 482-7546

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision262
Removal of skin lesions67
Removal of skin cancer1478
Removal or shaving of skin growth1-10
Skin biopsy12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT194482PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Jul 1, 2014 Accepting new patients
Aqua Dermatology of Florida, PA Dermatology CurrentSince Jul 1, 2014 Accepting new patients

Locations

2366 Surfside Blvd
Ste C111
Cape Coral, FL 33991
Phone (239) 360-2795

413 Del Prado Blvd S
Ste 101
Cape Coral, FL 33990
Phone (239) 443-1500

7331 Gladiolus Dr
Fort Myers, FL 33908
Phone (239) 437-8810

9400 Gladiolus Dr
Ste 320
Fort Myers, FL 33908
Phone (239) 482-7546

15051 S Tamiami Trl
Ste 203
Fort Myers, FL 33908
Phone (239) 732-5959

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: mlee@aquadermatology.emadirect.md

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1254009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1639403462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 S. TAMIAMI TRAIL",
            "address_2": "SUITE 203",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-437-8810",
            "fax_number": "239-313-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7331 GLADIOLUS DRIVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-437-8810",
            "fax_number": "239-437-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MICHAEL",
        "middle_name": "DOMINIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-27",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MT194482",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME116210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.