Individual provider Active NPI

Susan Y. Ly, MD

  • Emergency Medicine Physician
  • Worcester, MA
National Provider Identifier
1164682415
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
246431 Issued in MA
Practice address
55 Lake Ave N
Department of Emergency Medicine
Worcester, MA 01655-0002
Phone
(508) 421-1400
Fax
(508) 421-1490
NPI assigned
Jun 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 246431 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Department of Emergency Medicine
Worcester, MA 01655-0002

Mailing address

50 Pasadena Pkwy
Worcester, MA 01605-1635

Other identifiers 1

IdentifierTypeStateIssuer
110088143AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110818000109 MA Practitioner - Emergency Medicine 2365611829 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.3 of 100Reported as group
Quality
80.55
Improvement activities
40
Cost
75.2

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
246431MAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Merrimack Valley Emergency Associates, Inc. Emergency Medicine CurrentSince Aug 16, 2011 Accepting new patients

Locations

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341187200000",
    "number": "1164682415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 PASADENA PKWY",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-421-1400",
            "fax_number": "508-421-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "SUSAN",
        "middle_name": "Y.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-11",
        "last_updated": "2012-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "246431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110088143A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.