Jessica Genevieve Lee, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036155602 Issued in IL

Practice address

2850 W 95TH St Ste 400
Evergreen Park, IL 60805-2755

Phone

(708) 424-7600

NPI assigned

Mar 20, 2018

Sex

Female

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

• Jessica Genevieve Demaio Former name

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1649774142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 W 95TH ST STE 400",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052755",
            "telephone_number": "708-424-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 W 95TH ST STE 400",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052755",
            "telephone_number": "708-424-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JESSICA",
        "middle_name": "GENEVIEVE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-20",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.071712",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036155602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "DEMAIO",
            "middle_name": "GENEVIEVE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• LCR Primary Care LLC
• Naomi Marie Ledezma, MA
• Abby Lee, DMD, MS
• Erin Lee, LCSW
• Hae C. Lee, M.D.
• Timothy Lee
• Legend Home Health Care Professionals
• Leland C Lenahan III, M.D.
• Edgar V Lerma, M.D.
• Samantha Jordyn Levin, PA

• Pediatrics Physician in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.