Individual provider Active NPI

Kerry Thomas Lee, MD

  • Anesthesiology Physician
  • Greenwood, SC
National Provider Identifier
1760452296
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
19561 Issued in SC
Practice address
1325 Spring St
Greenwood, SC 29646-3860
Phone
(864) 725-4111
NPI assigned
Jan 26, 2006
Last updated
Mar 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 19561 SC Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 19561 SC

Addresses

Primary practice location

1325 Spring St
Greenwood, SC 29646-3860

Mailing address

PO Box 742324
Atlanta, GA 30374-2324
Phone (864) 227-8242

Other practice location 1

1325 Spring St
Anesthesia Dept
Greenwood, SC 29646-3860
Phone (864) 227-4111

Other identifiers 1

IdentifierTypeStateIssuer
195611MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20041006000794 SC Practitioner - AnesthesiologyPractitioner - Pain Management 0345209201 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19561SCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group Anesthesiology CurrentSince Apr 1, 2024 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Jul 1, 2004 Accepting new patients
Self Medical Group CurrentSince Apr 1, 2024 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Jul 1, 2004 Accepting new patients
Self Medical Group Current Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

420 Thomson Cir
Abbeville, SC 29620
Phone (864) 366-1649

901 W Greenwood St
Abbeville, SC 29620
Phone (864) 459-5011

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1760452296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742324",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742324",
            "telephone_number": "864-227-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Spring St",
            "address_2": "Anesthesia Dept",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296463860",
            "country_code": "US",
            "telephone_number": "864-227-4111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "KERRY",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "19561",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "SC",
            "license": "19561",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195611",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.