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JAEWON LEE CNP
NPI 1558815522
Nurse Practitioner - Family in Grants, NM

Active since August 08, 2016PECOS EnrolledAccepts Medicare Assignment
1217 BONITA ST, GRANTS, NM 87020(052) 872-9585(505) 443-8342 Get Directions Write a Review

NPPES record last updated: January 15, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 11, 2018, Feb 20, 2018, Aug 8, 2016 (3 updates tracked since 2016).

About Jaewon Lee Cnp NPPES

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

JAEWON LEE CNP (NPI 1558815522) is an individual family provider in Grants, New Mexico, licensed in New Mexico (66164) and active in the NPI registry since August 2016. He is enrolled in Medicare PECOS, is affiliated with Cibola General Hospital, and maintains a secondary practice location in Tell City.

NPPES Registry Identity

NPI1558815522
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameJAEWON LEECredential: CNP
Location Address1217 BONITA STGrants, NM 87020-2103
Mailing Address1217 Bonita StGrants, NM 87020-2103 · (052) 872-9585 · Fax (505) 443-8342
Phone(052) 872-9585
Fax(505) 443-8342
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateAugust 8, 2016
Last NPPES UpdateJanuary 15, 20253 updates tracked since enumeration
NPPES CertifiedJanuary 15, 2025
✔ NPI 1558815522 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in NM · 66164✔ Licensed in IN · F07161203
Also ListedNurse PractitionerTaxonomy 363L00000X · License 5905 (MN)
1217 BONITA ST, Grants, NM 87020
Open in Google Maps ↗

Other Names 1

Former Name (1)Jae Won Lee Cnp

Secondary Practice Location 1

Location 1109 US Highway 66 ETell City, IN 47586-2755 · Phone (812) 547-3447 · Fax (812) 547-9543

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jaewon Lee Cnp 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 ID5193004877
PECOS Enrollment IDI20231103001864
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.

Hospital Affiliations CMS Care Compare

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

Cibola General Hospital

Critical Access Hospitals · Grants, NM
OwnershipVoluntary non-profit - Private
CMS Certification Number321308
Location1016 E Roosevelt AvenueGrants, NM 87020 · Cibola County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 87020 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.79 typical visit price
range $54.26 – $166.80
Typical copayment $21.19 (range $13.56 – $41.70)
Most-billed visit code 99203
Established Patient
$96.38 typical visit price
range $17.00 – $135.35
Typical copayment $24.09 (range $4.25 – $33.83)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

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

MS. CHANDRA S. GORDON LADAC; LPC
Counselor (Addiction (Substance Use Disorder))
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 287-2273
DR. ANN EDMUNDS HEATH MD
Family Medicine
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 287-2950
PRESBYTERIAN MEDICAL SERVICES
Clinic/Center (Federally Qualified Health Center (FQHC))
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 287-2958
LITA C BAILLY FNP
Nurse Practitioner (Family)
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 287-2950
WINONA L GALINDO CCHW
Community Health Worker
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 287-2958
SHERRY ANN POLEN CNP
Nurse Practitioner (Family)
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 287-2958
MS. NICOLE NEAL LPCC
Counselor (Mental Health)
1217 BONITA ST, PMS DBA WNMMG
GRANTS, NM 87020
Cibola County (505) 287-2273
ASHLEI L ALLEN
Counselor
1217 BONITA ST
GRANTS, NM 87020
Cibola County (505) 471-5006

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 Jaewon Lee's NPI number?

The NPI number for Jaewon Lee is 1558815522. It was assigned to this individual provider in the NPPES registry on August 8, 2016. The provider is also known as Jae Won Lee Cnp.

Where is Jaewon Lee located?

Jaewon Lee practices at 1217 Bonita St, Grants, NM 87020. The listed phone number is (052) 872-9585.

What is Jaewon Lee's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jaewon Lee enrolled in Medicare?

Yes. Jaewon Lee 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.

Is Jaewon Lee affiliated with any hospitals?

According to CMS data, Jaewon Lee is affiliated with Cibola General Hospital.

When was this NPI record last updated?

The NPPES record for Jaewon Lee was last updated on January 15, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.