SEONG GON BAE M.D.
NPI 1114122769
Surgery in Lake Mary, FL
About Seong Gon Bae M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SEONG GON BAE M.D. (NPI 1114122769) is an individual surgery provider in Lake Mary, Florida, licensed in Florida (ME128524) and active in the NPI registry since June 2007. He is enrolled in Medicare PECOS, maintains a secondary practice location in Van Nuys, and is a graduate of University Of South Florida College Of Medicine (2005).
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Seong Gon Bae M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Seong Bae reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Orlando, FL 32803
- Reassigned Medicare billing, Florida enrollment
- 3,005 clinicians in this Medicare group
Van Nuys, CA 91405
- Reassigned Medicare billing, California enrollment
- Medicare enrollment name: Thomas J Lomis M D Inc A Professional Corporation
- 13 clinicians in this Medicare group
Sherman Oaks, CA 91411
- Reassigned Medicare billing, California enrollment
- 17 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 8
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 32746 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LAKE MARY, FL 32746
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Seong Bae's NPI number?
The NPI number for Seong Bae is 1114122769. It was assigned to this individual provider in the NPPES registry on June 15, 2007. The provider is also known as Samuel Bae M.D..
Where is Seong Bae located?
Seong Bae practices at 4106 W Lake Mary Blvd Ste 330, Lake Mary, FL 32746. The listed phone number is (407) 833-9195.
What is Seong Bae's specialty?
The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.
Is Seong Bae enrolled in Medicare?
Yes. Seong Bae is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Seong Bae's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Seong Bae reassigns Medicare benefits to 3 organizations: Florida Hospital Medical Group Inc (Orlando, FL), Thomas J Lomis, MD, Inc. A Professional Corporation (Van Nuys, CA) and Southern California Multi-Specialty Center Inc (Sherman Oaks, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Seong Bae's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Seong Bae was last updated on February 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Seong Gon Bae, M.D. · NPI 1114122769
Surgery physician in Lake Mary, Florida. Individual provider, active in the CMS NPPES registry since June 15, 2007.
## Identity
- **NPI:** 1114122769 (Entity type: Individual)
- **Enumerated:** June 15, 2007
- **Primary specialty:** Surgery · taxonomy 208600000X
- **State license:** ME128524 (Florida)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4106 W LAKE MARY BLVD STE 330, Lake Mary, FL 32746-3383
- **Phone:** (407) 833-9195
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Florida Hospital Medical Group Inc (NPI 1225034234, Orlando, FL); Thomas J Lomis, MD, Inc. A Professional Corporation (NPI 1982700035, Van Nuys, CA); Southern California Multi-Specialty Center Inc (NPI 1407326606, Sherman Oaks, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of South Florida College Of Medicine, class of 2005
## Record status
- **NPPES last updated:** February 6, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1114122769) · Data from the CMS NPPES public registry.