SOO MI LEE - SAMUEL MD
NPI 1275683211
Psychiatry & Neurology - Child & Adolescent Psychiatry in Crystal Lake, IL

Q: What is Soo Lee - Samuel's NPI number?

The NPI number for Soo Lee - Samuel is 1275683211. It was assigned to this individual provider in the NPPES registry on January 11, 2007. The provider is also known as Dr. Soo Mi Lee MD.

Q: What is Soo Lee - Samuel's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Q: When was this NPI record last updated?

The NPPES record for Soo Lee - Samuel was last updated on August 24, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.

Active since January 11, 2007PECOS EnrolledAccepts Medicare Assignment

390 E CONGRESS PKWY, SUITE J, CRYSTAL LAKE, IL 60014(815) 356-5050(815) 356-5094 Get Directions Write a Review

NPPES record last updated: August 24, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Soo Mi Lee - Samuel Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOO MI LEE - SAMUEL MD (NPI 1275683211) is an individual child & adolescent psychiatry provider in Crystal Lake, Illinois, licensed in Illinois (036-109024) and active in the NPI registry since January 2007. She is enrolled in Medicare PECOS, is affiliated with Northshore University Healthsystem - Evanston Hospital, and is a graduate of University Of Cincinnati College Of Medicine (1998).

NPPES Registry Identity

NPI1275683211

Entity TypeIndividualFemale

Primary Taxonomy2084P0804X

Provider Legal NameSOO MI LEE - SAMUELCredential: MD

Location Address390 E CONGRESS PKWY, SUITE JCrystal Lake, IL 60014-6202

Mailing Address1701 E. Woodfield Road, Suite 1000Schaumburg, IL 60173-5113 · (847) 240-2211 · Fax (847) 240-2418

Phone(815) 356-5050

Fax(815) 356-5094

Sole ProprietorNo

Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 1998

Enumeration DateJanuary 11, 2007

Last NPPES UpdateAugust 24, 2010

✔ NPI 1275683211 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0804X

License✔ Licensed in IL · 036-109024

Definition

Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

390 E CONGRESS PKWY, Crystal Lake, IL 60014

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Other Names 1

Former Name (1)Dr. Soo Mi Lee Md

Other Identifiers 3

Medicare PIN207844IL

Other32-0084889IL · Group Tax Id Number

Other1633897IL · Group Bcbs Number

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

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

Soo Mi Lee - Samuel Md 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.

PECOS PAC ID2567499841

PECOS Enrollment IDI20240621000456

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Soo Lee - Samuel reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Endeavor Health Medical Group

34 mi

Anesthesiology

2650 RIDGE AVE, ANESTHESIOLOGY ROOM 3905
Evanston, IL 60201

Reassigned Medicare billing, Illinois enrollment
4,841 clinicians in this Medicare group

NPI 1265695944 (847) 570-2760

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 2

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.

Psychiatric diagnostic evaluation with medical services 90792

A psychiatric diagnostic evaluation with medical services is a comprehensive assessment. It includes a detailed examination of your mental health and physical wellbeing, as well as your personal and family history. This evaluation aids in creating an effective treatment plan.

21 services21 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

18 services15 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northshore University Healthsystem - Evanston Hospital

Acute Care Hospitals · Evanston, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140010

Location2650 Ridge AveEvanston, IL 60201 · Cook County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SOVEREIGN REHABILITATION OF ILLINOIS, LLC

Clinic/Center (Physical Therapy)

390 E CONGRESS PKWY
CRYSTAL LAKE, IL 60014

McHenry County (773) 755-7566

GABRIELA GONZALEZ

Behavior Technician

390 E CONGRESS PKWY
CRYSTAL LAKE, IL 60014

McHenry County (779) 284-0347

DAVID WELCH LCPC

Counselor (Professional)

390 E CONGRESS PKWY, SUITE J
CRYSTAL LAKE, IL 60014

McHenry County (815) 356-5050

TIFFANY CUBBISON

Health and Wellness Coach

390 E CONGRESS PKWY
CRYSTAL LAKE, IL 60014

McHenry County (815) 322-9300

DR. KATHRYN SCHOENBROD M.D.

Psychiatry & Neurology (Psychiatry)

390 E CONGRESS PKWY, SUITE J
CRYSTAL LAKE, IL 60014

McHenry County (815) 356-5050

MRS. PAULA FRANCES FICK OTR/L

Occupational Therapist

390 E CONGRESS PKWY, SUITE A
CRYSTAL LAKE, IL 60014

McHenry County (815) 477-4788

NANETTE LASCO MSW, LCSW

Social Worker (Clinical)

390 E CONGRESS PKWY, SUITE J
CRYSTAL LAKE, IL 60014

McHenry County (815) 356-5050

AMANDA ELIZABETH GARBIS

Behavior Technician

390 E CONGRESS PKWY
CRYSTAL LAKE, IL 60014

McHenry County (779) 284-0347

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 Soo Lee - Samuel's NPI number?

The NPI number for Soo Lee - Samuel is 1275683211. It was assigned to this individual provider in the NPPES registry on January 11, 2007. The provider is also known as Dr. Soo Mi Lee MD.

Where is Soo Lee - Samuel located?

Soo Lee - Samuel practices at 390 E Congress Pkwy Suite J, Crystal Lake, IL 60014. The listed phone number is (815) 356-5050.

What is Soo Lee - Samuel's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Is Soo Lee - Samuel enrolled in Medicare?

Yes. Soo Lee - Samuel 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 organization bills Medicare for Soo Lee - Samuel's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Soo Lee - Samuel reassigns Medicare benefits to Endeavor Health Medical Group (Evanston, IL). The 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 Soo Lee - Samuel's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Soo Lee - Samuel accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Soo Lee - Samuel as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Soo Lee - Samuel affiliated with any hospitals?

According to CMS data, Soo Lee - Samuel is affiliated with Northshore University Healthsystem - Evanston Hospital.

When was this NPI record last updated?

The NPPES record for Soo Lee - Samuel was last updated on August 24, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.