SOO MI LEE - SAMUEL MD
NPI 1275683211
Psychiatry & Neurology - Child & Adolescent Psychiatry in Crystal Lake, IL
NPI Status: Active since January 11, 2007
Contact Information
390 E CONGRESS PKWY
SUITE J
CRYSTAL LAKE, IL
ZIP 60014
Phone: (815) 356-5050
Fax: (815) 356-5094
- Individual
- Female
- Years of Experience 28
- Psychiatry & Neurology
- Child & Adolescent Psychiatry
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About SOO LEE - SAMUEL
This page provides the complete NPI Profile along with additional information for Soo Lee - Samuel, a provider established in Crystal Lake, Illinois with a medical specialization in Psychiatry & Neurology, focusing in child & adolescent psychiatry and more than 28 years of experience. She graduated from University Of Cincinnati College Of Medicine in 1998. The healthcare provider is registered in the NPI registry with number 1275683211 assigned on January 2007. The practitioner's primary taxonomy code is 2084P0804X with license number 036-109024 (IL). The provider is registered as an individual and her NPI record was last updated 15 years ago.
- NPI
- 1275683211
- Provider Name
- SOO MI LEE - SAMUEL MD
- Other Name
- DR. SOO MI LEE MD
- Other Name Type
- Former Name (1)
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014
- Location Phone
- (815) 356-5050
- Location Fax
- (815) 356-5094
- Mailing Address
- 1701 E. WOODFIELD ROAD SUITE 1000 SCHAUMBURG, IL 60173
- Mailing Phone
- (847) 240-2211
- Mailing Fax
- (815) 356-5094
- Medical School Name
- UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
- Graduation Year
- 1998
- Is Sole Proprietor?
- No
- Enumeration Date
- 01-11-2007
- Last Update Date
- 08-24-2010
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychiatry & Neurology Child & Adolescent Psychiatry
- Taxonomy Code
- 2084P0804X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 036-109024
- License State
- IL
- Taxonomy Description
- 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.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze 1 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - PPO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Complete Silver - EPO
- Complete Silver + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Premier Silver - EPO
- Premier Silver + Vision + Adult Dental - EPO
- Standard Expanded Bronze - EPO
- Standard Expanded Bronze + Vision + Adult Dental - EPO
- Standard Gold - EPO
- Standard Gold + Vision + Adult Dental - EPO
- Standard Silver - EPO
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Clear Silver - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Elite Silver - HMO
- Elite Silver + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Focused Silver - HMO
- Focused Silver + Vision + Adult Dental - HMO
- Standard Expanded Bronze - HMO
- Standard Expanded Bronze + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Premier Bronze HSA - EPO
- Premier Bronze HSA + Vision + Adult Dental - EPO
- Standard Expanded Bronze - EPO
- Standard Expanded Bronze + Vision + Adult Dental - EPO
- Standard Gold - EPO
- Standard Gold + Vision + Adult Dental - EPO
- Standard Silver - EPO
- Central Bronze - HMO
- Central Bronze + Vision + Adult Dental - HMO
- Central Gold - HMO
- Central Gold + Vision + Adult Dental - HMO
- Clear Silver - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Focused Silver - HMO
- Focused Silver + Vision + Adult Dental - HMO
- Standard Expanded Bronze - HMO
- Standard Expanded Bronze + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Standard Gold + Vision + Adult Dental - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Blue Choice Preferred Bronze PPO? 201 - PPO
- Blue Choice Preferred Bronze PPO? 701 - PPO
- Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays - PPO
- Blue Choice Preferred Gold PPO? 204 - PPO
- Blue Choice Preferred Gold PPO? 901 - PPO
- Blue Choice Preferred Gold PPO? Standard - Rx Copays - PPO
- Blue Choice Preferred Security PPO? 200 - PPO
- Blue Choice Preferred Silver PPO? 203 - PPO
- Blue Choice Preferred Silver PPO? 801 - PPO
- Blue Choice Preferred Silver PPO? Standard - Select Rx Copays - PPO
- MyBlue Plus Bronze? 903 - POS
- MyBlue Plus Bronze? 912 - POS
- MyBlue Plus Bronze? Standard - Select Rx Copays - POS
- MyBlue Plus Gold? 909 - POS
- MyBlue Plus Gold? 910 - POS
- MyBlue Plus Gold? Standard - Rx Copays - POS
- MyBlue Plus Silver? 905 - POS
- MyBlue Plus Silver? 906 - POS
- MyBlue Plus Silver? Standard - Select Rx Copays - POS
- Connect Bronze 2000 Indiv Med Deductible - HMO
- Connect Bronze 5000 Indiv Med Deductible - Rx Copay - HMO
- Connect Bronze CMS Standard - HMO
- Connect Gold CMS Standard - Rx Copay - HMO
- Connect Silver 3000 Indiv Med Deductible - Rx Copay - HMO
- Connect Silver CMS Standard - HMO
- UHC Bronze Copay Focus (No Referrals) - HMO
- UHC Bronze Standard (No Referrals) - HMO
- UHC Bronze Value (Rx Copay, No Referrals) - HMO
- UHC Bronze Value+ (Rx Copay, Dental + Vision, No Referrals) - HMO
- UHC Gold Advantage (No Referrals) - HMO
- UHC Gold Advantage+ (Dental + Vision, No Referrals) - HMO
- UHC Gold Copay Focus (No Referrals) - HMO
- UHC Gold Standard (Rx Copay, No Referrals) - HMO
- UHC Silver Advantage (Rx Copay, No Referrals) - HMO
- UHC Silver Advantage+ (Rx Copay, Dental + Vision, No Referrals) - HMO
- UHC Silver Copay Focus (No Referrals) - HMO
- UHC Silver Standard (No Referrals) - HMO
- UHC Silver Standard+ (Dental + Vision, No Referrals) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 207844 | MEDICARE PIN (08) | IL | |
| 32-0084889 | OTHER (01) | IL | GROUP TAX ID NUMBER |
| 1633897 | OTHER (01) | IL | GROUP BCBS NUMBER |
Medicare Participation & PECOS Enrollment Status
Soo Lee - Samuel is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Soo Lee - Samuel is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 2567499841
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20240621000456
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Soo Lee - Samuel is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| NORTHSHORE UNIVERSITY HEALTHSYSTEM - EVANSTON HOSPITAL | 2650 RIDGE AVE EVANSTON, IL 60201 | (847) 432-8000 | Acute Care Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 7 | 5 | 6 | 8 | 3 | 2 | 1 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 14 | 5 | 12 | 8 | 6 | 2 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 1 + 4 + 5 + 1 + 2 + 8 + 6 + 2 + 2 + 24 = 59 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 59 = 1 | 1 | ||||||||
The NPI number 1275683211 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1790887040 | JEANA ALTMAN LCPC Individual | Counselor (Professional) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1932288115 | MRS. ELLEN FAYE ERLICHMAN LCSW Individual | Social Worker | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1114097177 | NANETTE LASCO MSW, LCSW Individual | Social Worker (Clinical) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1760552731 | JANICE SPANGLER PSYD Individual | Psychologist (Clinical) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1063582047 | DAVID WELCH LCPC Individual | Counselor (Professional) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1477610665 | DR. DAVID A GOODMAN MD PHD Individual | Otolaryngology | 390 E CONGRESS PKWY UNIT M CRYSTAL LAKE, IL 60014 (815) 455-0858 |
| 1366568032 | MERCY HEATLH SYSTEM CORPORATION Organization | Durable Medical Equipment & Medical Supplies | 390 E CONGRESS PKWY STE M CRYSTAL LAKE, IL 60014 (815) 444-0850 |
| 1154545432 | REBECCA LYNN HAHNFELD LCPC Individual | Counselor (Professional) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1104027663 | DR. KATHRYN SCHOENBROD M.D. Individual | Psychiatry & Neurology (Psychiatry) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1013228790 | SOVEREIGN REHABILITATION OF ILLINOIS, LLC Organization | Clinic/Center (Physical Therapy) | 390 E CONGRESS PKWY CRYSTAL LAKE, IL 60014 (773) 755-7566 |
| 1538477542 | CRONIN MEDICAL GROUP, LTD. Organization | Clinic/Center (Primary Care) | 390 E CONGRESS PKWY SUITE H CRYSTAL LAKE, IL 60014 (815) 477-4600 |
| 1447559315 | MRS. AMY MARIE FINNERTY MS CCC-SLP-L Individual | Speech-Language Pathologist | 390 E CONGRESS PKWY UNIT A CRYSTAL LAKE, IL 60014 (847) 477-4788 |
| 1104175447 | MRS. PAULA FRANCES FICK OTR/L Individual | Occupational Therapist | 390 E CONGRESS PKWY SUITE A CRYSTAL LAKE, IL 60014 (815) 477-4788 |
| 1215064365 | KATHERINE ANN GODFREY MD Individual | Psychiatry & Neurology (Child & Adolescent Psychiatry) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1720425465 | MRS. CARISSA LYNN THIELE MS, CCC-SLP Individual | Speech-Language Pathologist | 390 E CONGRESS PKWY SUITE A CRYSTAL LAKE, IL 60014 (815) 477-4788 |
| 1225453459 | STEVE J KIM MA, LCPC Individual | Counselor (Professional) | 390 E CONGRESS PKWY SUITE J CRYSTAL LAKE, IL 60014 (815) 356-5050 |
| 1518367911 | MRS. COLLEEN ANN RODGERS COTA Individual | Occupational Therapy Assistant | 390 E CONGRESS PKWY CRYSTAL LAKE, IL 60014 (815) 477-4788 |
| 1689743767 | DR. MICHAEL JOSEPH LOUISE D.C. Individual | Chiropractor | 390 E CONGRESS PKWY SUITE F CRYSTAL LAKE, IL 60014 (815) 356-5000 |
| 1134578453 | MRS. NICOLE A GLINSKI B.S, COTA/L Individual | Occupational Therapy Assistant | 390 E CONGRESS PKWY CRYSTAL LAKE, IL 60014 (815) 477-4788 |
| 1730632407 | JOANNA HUTSON NP-C Individual | Nurse Practitioner | 390 E CONGRESS PKWY SUITE C CRYSTAL LAKE, IL 60014 (815) 301-1001 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1275683211, enumerated in the NPI registry as an "individual" on January 11, 2007
The provider is located at 390 E Congress Pkwy Suite J Crystal Lake, Il 60014 and the phone number is (815) 356-5050
The provider's speciality is Psychiatry & Neurology with taxonomy code 2084P0804X with a focus in Child & Adolescent Psychiatry
The provider has more than 28 years of experience. She graduated from University Of Cincinnati College Of Medicine in 1998.
The provider might be accepting Accepts: Aetna CVS Health, Ambetter from Home State Health,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
The practitioner is affiliated to the following hospital(s): NORTHSHORE UNIVERSITY HEALTHSYSTEM - EVANSTON HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on January 11, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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