Individual provider Active NPI

Robert W Lee II, ACNP, RN

  • Acute Care Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1801164363
Registry record updated May 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R869297 Issued in MS
Practice address
6051 U S Highway 49
Hattiesburg, MS 39401-7200
Phone
(800) 494-8260
NPI assigned
Dec 12, 2011
Last updated
May 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R869297 MS Primary

Addresses

Primary practice location

6051 U S Highway 49
Hattiesburg, MS 39401-7200

Mailing address

5000 W 4TH St
Hattiesburg, MS 39402-1000
Phone (800) 494-8260

Other identifiers 1

IdentifierTypeStateIssuer
09252360MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170705000154 MS Practitioner - Nurse Practitioner 0749559995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Radiology Services PLLCGroup PAC ID 1759364946, 50 clinicians

Practice addresses (Care Compare)

6051 U S Hwy 49
Comprehensive Radiology
Hattiesburg, MS 39401-7200
Phone (601) 288-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R869297MSMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Radiology Services, PLLC CurrentSince Jun 1, 2017 Accepting new patients

Locations

178 Highway 24 E
Centreville, MS 39631
Phone (601) 645-5221

5000 W 4th St
Hattiesburg, MS 39402
Phone (601) 264-2121

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

347 Magnolia Dr
Raleigh, MS 39153
Phone (601) 374-9070

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1323648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558396800000",
    "number": "1801164363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 W 4TH ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021000",
            "telephone_number": "800-494-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 U S HIGHWAY 49",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017200",
            "telephone_number": "800-494-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "ROBERT",
        "middle_name": "W",
        "name_suffix": "II",
        "credential": "ACNP, RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-12",
        "last_updated": "2019-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R869297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09252360",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.