Individual provider Active NPI

John Yongkwon Lee, MD

  • Surgery Physician
  • Placerville, CA
National Provider Identifier
1952742207
Registry record updated May 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A126392 Issued in CA
Practice address
1095 Marshall Way
Suite 202
Placerville, CA 95667-5722
Phone
(530) 626-3682
NPI assigned
Jul 16, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A126392 CA Primary

Addresses

Primary practice location

1095 Marshall Way
Suite 202
Placerville, CA 95667-5722

Mailing address

PO Box 45680
San Francisco, CA 94145-0680
Phone (530) 626-3682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20130807000163 CA Practitioner - General Surgery 3779725551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

999 S Fairmont Ave
Suite 100
Lodi, CA 95240-5140
Phone (209) 334-2010

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
126392CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Surgery CurrentSince Oct 1, 2017 Accepting new patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Oct 1, 2017 Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients

Locations

1524 W Lacey Blvd
Ste 101
Hanford, CA 93230
Phone (559) 583-4695

999 S Fairmont Ave
Ste 100
Lodi, CA 95240
Phone (209) 334-2010

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: john.lee.1@8236.direct.athenahealth.com

Organizations & group practices 4

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": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495843200000",
    "number": "1952742207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45680",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941450680",
            "telephone_number": "530-626-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MARSHALL WAY",
            "address_2": "SUITE 202",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675722",
            "telephone_number": "530-626-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JOHN",
        "middle_name": "YONGKWON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-16",
        "last_updated": "2017-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A126392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Placerville, CA

Sources for this page

Verify at the official NPI Registry.