Individual provider Active NPI

Robert Lee

  • Psychologist
  • Exton, PA
National Provider Identifier
1992102602
Registry record updated May 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS017741 Issued in PA
Practice address
467 Creamery Way
Exton, PA 19341-2508
Phone
(610) 363-1488
NPI assigned
Nov 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS017741 PA Primary

Addresses

Primary practice location

467 Creamery Way
Exton, PA 19341-2508

Mailing address

482 S Landmark Ave
Bloomington, IN 47403-5000
Phone (812) 333-8474

Other practice location 1

482 S Landmark Ave
Bloomington, IN 47403-5000
Phone (812) 333-8474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240617000881 IN Practitioner - Clinical Psychologist 1759606254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jennifer Spencer PHD HSPP PCGroup PAC ID 0244384758, 9 clinicians

Practice addresses (Care Compare)

482 S Landmark Ave
Bloomington, IN 47403-5000
Phone (812) 333-8474

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jennifer Spencer PHD HSPP PC CurrentSince Jun 10, 2024 Accepting new patients

Locations

482 S Landmark Ave
Bloomington, IN 47403
Phone (812) 333-8474

1312 W Arch Haven Ave
Ste A
Bloomington, IN 47403
Phone (812) 333-8474

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714867200000",
    "number": "1992102602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035000",
            "telephone_number": "812-333-8474",
            "fax_number": "812-961-3804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 CREAMERY WAY",
            "city": "EXTON",
            "state": "PA",
            "postal_code": "193412508",
            "telephone_number": "610-363-1488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "482 S Landmark Ave",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474035000",
            "country_code": "US",
            "telephone_number": "812-333-8474",
            "fax_number": "812-961-3804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-24",
        "last_updated": "2024-05-05",
        "certification_date": "2024-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS017741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Exton, PA

Sources for this page

Verify at the official NPI Registry.