Active NPI
Michael Lilly, MD
- Student in an Organized Health Care Education/Training Program
- Norton, VA
National Provider Identifier
1083111025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 96 15TH St NW Ste 111
Norton, VA 24273-1600 - Phone
- (276) 439-1871
- NPI assigned
- Apr 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 0101283381 | VA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
96 15TH St NW Ste 111
Norton, VA 24273-1600
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111
Other practice location 1
27005 76th Ave
New Hyde Park, NY 11040-1402
Phone (718) 470-4475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241120003513 | VA | Practitioner - Internal Medicine | 8628503125 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732752000000",
"number": "1083111025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 W OAKLAND AVE STE 310",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376042192",
"telephone_number": "423-952-2111",
"fax_number": "423-282-1657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 15TH ST NW STE 111",
"city": "NORTON",
"state": "VA",
"postal_code": "242731600",
"telephone_number": "276-439-1871"
}
],
"practiceLocations": [
{
"address_1": "27005 76th Ave",
"address_purpose": "LOCATION",
"city": "New Hyde Park",
"state": "NY",
"postal_code": "110401402",
"country_code": "US",
"telephone_number": "718-470-4475",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LILLY",
"first_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-06",
"last_updated": "2024-11-28",
"certification_date": "2024-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0101283381",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Norton, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.