Active NPI
Austin Ly
- Student in an Organized Health Care Education/Training Program
- Mishawaka, IN
National Provider Identifier
1265248991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468 - Phone
- (574) 335-6500
- NPI assigned
- Dec 7, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
611 E Douglas Rd Ste 407
Mishawaka, IN 46545-1468
Mailing address
1669 Riverside Dr Apt B
South Bend, IN 46616-1637
Phone (260) 437-7040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20250605003692 | IN | Order and Referring Only - Family Practice | 8527578970 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- aly2668952@direct.trinity-health.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748390400000",
"number": "1265248991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1669 RIVERSIDE DR APT B",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466161637",
"telephone_number": "260-437-7040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 E DOUGLAS RD STE 407",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451468",
"telephone_number": "574-335-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "AUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-07",
"last_updated": "2025-05-28",
"certification_date": "2025-05-28",
"status": "A"
},
"taxonomies": [
{
"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 Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.