Individual provider Active NPI

Edward T. Lee, MD

  • Obstetrics & Gynecology Physician
  • Deerfield, IL
National Provider Identifier
1881753226
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036-096268 Issued in IL
Practice address
190 Waukegan Rd Ste B
Deerfield, IL 60015-5655
Phone
(847) 945-4575
Fax
(847) 941-7697
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036-096268 IL Primary

Addresses

Primary practice location

190 Waukegan Rd Ste B
Deerfield, IL 60015-5655

Mailing address

2650 Ridge Ave
Evanston Hospital
Evanston, IL 60201-1718
Phone (847) 570-1206

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elee9904@direct.northshore.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20050914000275 IL Practitioner - Obstetrics/Gynecology 7214960954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Northwestern University Feinberg Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

225 N Milwaukee Ave
Vernon Hills, IL 60061-4304
Phone (847) 941-7600

2650 Ridge Ave
Evanston, IL 60201-1700

7900 Rollins Rd
Gurnee, IL 60031-1512

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-096268ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Obstetrics & Gynecology CurrentSince Oct 20, 2006 Accepting new patients
Endeavor Health Medical Group CurrentSince Oct 20, 2006 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
#100
Deerfield, IL 60015
Phone (847) 945-4575

190 Waukegan Rd
Ste B
Deerfield, IL 60015
Phone (847) 945-4575

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

49 S Waukegan Rd
Ste 100
Deerfield, IL 60015
Phone (847) 945-4575

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

7900 Rollins Rd
Gurnee, IL 60031
Phone (847) 356-3680

7900 Rollins Rd
Lowr
Gurnee, IL 60031

830 W End Ct
Ste 500
Vernon Hills, IL 60061
Phone (847) 522-8900

225 N Milwaukee Ave
Vernon Hills, IL 60061
Phone (847) 941-7600

Interoperability endpoints

  • Direct secure messaging: elee9904@direct.northshore.org

Organizations & group practices 2

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": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1881753226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "EVANSTON HOSPITAL",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-1206",
            "fax_number": "847-570-1248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 WAUKEGAN RD STE B",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600155655",
            "telephone_number": "847-945-4575",
            "fax_number": "847-941-7697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "EDWARD",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-096268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elee9904@direct.northshore.org",
            "affiliation": "N",
            "address_1": "49 S Waukegan Rd Ste 100",
            "city": "Deerfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600155204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Deerfield, IL

Sources for this page

Verify at the official NPI Registry.