Johnathan Tyree Dietrich Lee, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110005004 Issued in VA

Practice address

6333 Center Dr
Interstate Corporate Center # 16
Norfolk, VA 23502-4126

Phone

(540) 448-0719

NPI assigned

Jun 4, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians of TidewaterGroup PAC ID 5092618462, 167 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Princess Anne Hospital Hospital, Virginia Beach, VA, CCN 490119

Merit-based Incentive Payment System (MIPS)

Final score

97.87 of 100Reported as group

Quality

95.04

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

84.24 of 100Reported as group

Quality

75.4

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Emergency Physicians of Tidewater

  • Emergency Medicine Physician
  • Norfolk, VA
  • NPI 1033136841
  Medicare reassignment Care Compare group
• Mep Health, LLC

  • Emergency Medicine Physician
  • Rockville, MD
  • NPI 1164483558

  VA

  Medicare reassignment
• North Carolina Em-1 Medical Services, PC

  • Physician Assistant
  • Elizabethtown, NC
  • NPI 1306130695
  NPD
• Waterway Emergency Physicians LLC

  • Emergency Medicine Physician
  • Elizabeth City, NC
  • NPI 1487804670
  NPD (past)

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

• Sentara Princess Anne Hospital

  • General Acute Care Hospital
  • Virginia Beach, VA
  • NPI 1528028396
  Care Compare affiliation

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1790165686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 CENTER DR",
            "address_2": "INTERSTATE CORPORATE CENTER # 16",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024126",
            "telephone_number": "540-448-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 CENTER DR",
            "address_2": "INTERSTATE CORPORATE CENTER # 16",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024126",
            "telephone_number": "540-448-0719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JOHNATHAN",
        "middle_name": "TYREE DIETRICH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110005004",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA MEDICAL LICENSE",
            "identifier": "0110005004",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Dongjun Lee, D.M.D.
• Geunjae Lee
• Hong Min Lee, MD
• Jessica Lee, PA
• John J Lee, D.O.
• Juanita Rose Lee, FNP
• Lauren Elizabeth Lee
• Michael E Lee, MD
• Millie Lee, MD
• Misty A Lee, NP

• Medical Physician Assistant in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.