Individual provider Active NPI

Nicholas Lee

  • Student in an Organized Health Care Education/Training Program
  • Orange, CA
National Provider Identifier
1689092140
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
101 The City Dr S
City Tower, Suite 400
Orange, CA 92868-3201
Phone
(714) 456-6693
NPI assigned
Apr 2, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

101 The City Dr S
City Tower, Suite 400
Orange, CA 92868-3201

Mailing address

393 E Walnut St FL 3
PHR Group Provider Enrollment Unit
Pasadena, CA 91188-0001
Phone (877) 608-0044

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20171019001595 CA Practitioner - HospitalistPractitioner - Internal Medicine 2264738970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Western University of Health Sciences College of Dental Med, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

4647 Zion Ave
San Diego, CA 92120-2507
Phone (619) 528-5000

9455 Clairemont Mesa Blvd
San Diego, CA 92123-1297
Phone (858) 573-1504

Hospital & facility affiliations

  • Kaiser Foundation Hospital - San Diego Hospital, San Diego, CA, CCN 050515

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Sep 11, 2017 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 11, 2017 Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1689092140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST FL 3",
            "address_2": "PHR GROUP PROVIDER ENROLLMENT UNIT",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "877-608-0044",
            "fax_number": "877-514-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "address_2": "CITY TOWER, SUITE 400",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2021-12-01",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.