SEONG GON BAE (M.D.) – Surgery Physician, NPI 1114122769

SEONG GON BAE (M.D.) is a healthcare provider. based in Lake mary, Florida. specializing in GENERAL SURGERY. They hold the professional credentials M.D.. They hold a License No. A123341 (CA). The NPI Number for SEONG GON BAE (M.D.) is 1114122769

Main info

Male
Sole Proprietor
21 Years Of Experience
Accepts Medicare Assignment
Name
SEONG GON BAE (M.D.)
NPI
1114122769
Phone
(407) 833-9195
Address
4106 W LAKE MARY BLVD STE 330
Enumeration Date
15 June 2007
Last Update Date
6 February 2023

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE
Secondary Phone
8187823255
Graduation Year
2005 (21 years ago)
PAC ID
6800049719
Group Practice PAC ID
9739145806
Professional Enrollment ID
I20121228000420
Address ID
CA914053623VA15211STXX301
Telehealth
Yes

Contacts

SOAP Endpoint
https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience74
Completeness85
Years active:18State licenses:2Other namesUpdated within 12 months

2,163 GENERAL SURGERY in FL

Provider Addresses for SEONG GON BAE (M.D.)

  • 4106 W LAKE MARY BLVD STE 330

    LAKE MARY, FL 327463383

    Phone: (407) 833-9195

    Type: Mailing

  • 15211 Vanowen St Unit 200

    Van Nuys, CA 914053606

    Phone: (818) 782-3255

    Fax: (818) 782-7026

    Type: Location

  • West Olympic Boulevard, Mid-Wilshire, Los Angeles, Los Angeles County, California, 90064, United States

    SUITE 201

    LOS ANGELES, CA 900062567

    Phone: (305) 542-7792

    Fax: (213) 797-5925

    Type: Mailing

  • 230 S JACKSON ST APT 309

    GLENDALE, CA 912051592

    Phone: (818) 782-3255

    Fax: (818) 782-7026

    Type: Mailing

  • 15211 VANOWEN ST UNIT 200

    VAN NUYS, CA 914053606

    Phone: (818) 782-3255

    Fax: (818) 782-7026

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $87.

Total Amount is formed as General ($87) + Research ($0) + Ownership ($0) = $87.

Last reported payment date: 2023-09-06 • Largest payer in this snapshot: Karyopharm Therapeutics Inc. ($29).

Total Amount

$87

General + Research + Ownership

Payments

4

Total payment records

General Amount

$87

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-09-06

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-10-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20121228000420IGeneral SurgeryCATBD
I20221013001690IGeneral SurgeryFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes18097$0
99223Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes10899$0
99205New patient office or other outpatient visit, 60-74 minutes2626$0
99215Established patient office or other outpatient visit, 40-54 minutes2016$0
47562Removal of gallbladder using an endoscope1717$0
View full utilization report →

Insurance plans in this area (ZIP 32746)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9739145806View full group profile
NameSpecialtyState
General Surgery, Surgical OncologyCA
General Surgery, Surgical OncologyCA
Diagnostic RadiologyCA
Peripheral Vascular Disease, Vascular SurgeryCA
General SurgeryCA
Nuclear MedicineCA
General SurgeryCA
Peripheral Vascular Disease, Vascular SurgeryCA
General SurgeryCA

Reviews

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Frequently asked questions

What identifier follows SEONG GON BAE (M.D.) across health systems?
The NPI 1114122769 uniquely identifies SEONG GON BAE (M.D.) in U.S. healthcare data.
Is SEONG GON BAE (M.D.)'s NPI status active today?
Active status means SEONG GON BAE (M.D.)'s NPI record is not deactivated in the public file.
What does the directory say SEONG GON BAE (M.D.) does?
Insurance directories may phrase it differently, but here SEONG GON BAE (M.D.) maps to Surgery Physician. Clinical services aligned with this taxonomy classification.
Can patients visit SEONG GON BAE (M.D.) in Lake Mary, Florida?
For routing, start with Lake Mary, Florida for SEONG GON BAE (M.D.), then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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