NPIMap

Individual provider Active NPI

Mary S Lee, MD

  • Internal Medicine Physician
  • West Bloomfield, MI
National Provider Identifier
1932180817
Registry record updated Jan 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301061252 Issued in MI
Practice address
5799 W Maple Rd Ste 163
West Bloomfield, MI 48322-4458
Phone
(248) 419-5111
Fax
(248) 419-5112
NPI assigned
Nov 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301061252 MI
Internal Medicine Physician 207R00000X 4301061252 MI Primary

Addresses

Primary practice location

5799 W Maple Rd Ste 163
West Bloomfield, MI 48322-4458

Mailing address

5799 W Maple Rd Ste 163
West Bloomfield, MI 48322-4458
Phone (248) 419-5111

Other identifiers 1

IdentifierTypeStateIssuer
1598296485MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071025000600 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 9739276544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Wayne State University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5799 W Maple Rd
Suite 163
West Bloomfield, MI 48322-4458
Phone (248) 419-5111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301061252MIMDPediatrics Physician

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515369600000",
    "number": "1932180817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5799 W MAPLE RD STE 163",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224458",
            "telephone_number": "248-419-5111",
            "fax_number": "248-419-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5799 W MAPLE RD STE 163",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224458",
            "telephone_number": "248-419-5111",
            "fax_number": "248-419-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MARY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2018-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301061252",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301061252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598296485",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bloomfield, MI

Sources for this page

Verify at the official NPI Registry.