Individual provider Active NPI

Mark S. Lee, MD

  • Family Medicine Physician
  • Bella Vista, AR
National Provider Identifier
1679515522
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-5265 Issued in AR
Practice address
1 Mercy Way
Bella Vista, AR 72714-3000
Phone
(479) 802-5555
Fax
(479) 876-2829
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E-5265 AR Primary
Emergency Medicine Physician 207P00000X E5265 AR

Addresses

Primary practice location

1 Mercy Way
Bella Vista, AR 72714-3000

Mailing address

1 Mercy Way
Bella Vista, AR 72714-3000
Phone (479) 802-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20071130000244 AR Practitioner - Family PracticePractitioner - Emergency Medicine 9830173285 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E5265ARMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 16, 2007 Accepting new patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Aug 15, 2014 Accepting new patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 16, 2007 Accepting new patients
The Covenant Group PA Emergency Medicine Past Accepting new patients
Goppert - Trinity Family Care, LLC Family Medicine Past Accepting new patients

Locations

1 Mercy Way
Bella Vista, AR 72714
Phone (479) 802-5555

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

Interoperability endpoints

  • Direct secure messaging: mlee17191@directc.mercy.net

Organizations & group practices 6

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491436800000",
    "number": "1679515522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MERCY WAY",
            "city": "BELLA VISTA",
            "state": "AR",
            "postal_code": "727143000",
            "telephone_number": "479-802-5555",
            "fax_number": "479-876-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERCY WAY",
            "city": "BELLA VISTA",
            "state": "AR",
            "postal_code": "727143000",
            "telephone_number": "479-802-5555",
            "fax_number": "479-876-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MARK",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-5265",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E5265",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bella Vista, AR

Sources for this page

Verify at the official NPI Registry.