Chheng Ly

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9115734 Issued in FL

Practice address

5309 E State Road 64
Bradenton, FL 34208-5534

Phone

(941) 747-9818

NPI assigned

Oct 21, 2020

Last updated

Jan 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Group practices

H Lee Moffitt Cancer Ctr and Res Inst Life Time Cancer SCRN Ctr IncGroup PAC ID 2264337021, 1,145 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• H Lee Moffitt Cancer Center & Research Institute I Hospital, Tampa, FL, CCN 100271

Merit-based Incentive Payment System (MIPS)

Final score

88 of 100Reported as group

Quality

74.04

Promoting interoperability

100

Improvement activities

40

Cost

70.96

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

• H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer SCRN Ctr Inc

  dba Moffitt Medical Group

  • Hematology & Oncology Physician
  • Tampa, FL
  • NPI 1306833595
  Medicare reassignment Care Compare group
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000

  Family Medicine

  Medicare reassignment NPD
• SMH Physician Services Inc

  dba First Physicians Group

  • Internal Medicine Physician
  • Sarasota, FL
  • NPI 1346295292

  Family Medicine

  Medicare reassignment NPD
• MCR Health, Inc.

  dba Riverside Medical Center

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD
• The Vidal Womans Medical Clinic Inc.

  • Primary Care Clinic/Center
  • Los Angeles, CA
  • NPI 1326133687
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.

  • Special Hospital
  • Tampa, FL
  • NPI 1780653618
  Care Compare affiliation

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1235738204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RIVERFRONT BLVD STE 710",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058812",
            "telephone_number": "941-776-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5309 E STATE ROAD 64",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085534",
            "telephone_number": "941-747-9818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Floyd St",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342392932",
            "country_code": "US",
            "telephone_number": "941-366-9222",
            "fax_number": "941-365-2269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LY",
        "first_name": "CHHENG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58645",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas J Lustberg, MD FACS
• Marcela Lutthans, M.S., CCC-SLP
• Luxottica of America Inc (Target Optical Q350)
• Luxottica of America Inc. (Lenscrafters #805)
• Luxottica Retail North America Inc (Sears Optical #C0516)
• Andrew Michael Lynch, PHARMD
• Lance Bradford Lyons, PA-C
• M Power Therapeutics
• M. Patrick Ardoin II, DDS, PA
• Aylin Ma

• Physician Assistant in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.