Phuong CHI Ly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A53516 Issued in CA

Practice address

26800 Crown Valley Pkwy Ste 150
Mission Viejo, CA 92691-8018

Phone

(949) 276-2111

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR, CA2 enrollments

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 2

Specialty

Family Practice

Education

University of Arkansas College of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD (past)
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1861721839
  Medicare reassignment NPD
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1609925957
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Mobile Health Unit

  • Mobile Mammography Clinic/Center
  • Jonesboro, AR
  • NPI 1417721689
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic

  • Clinical Medical Laboratory
  • Jonesboro, AR
  • NPI 1801127030
  NPD
• Anaheim Memorial Medical Center

  • General Acute Care Hospital
  • Anaheim, CA
  • NPI 1295782381
  NPD (past)
• Forrest City Arkansas Hospital Company LLC

  dba Forrest City Medical Center

  • General Acute Care Hospital
  • Forrest City, AR
  • NPI 1811912009
  NPD (past)
• Marianna Family Medicine Clinic PLLC

  • Family Medicine Physician
  • Marianna, AR
  • NPI 1073693701
  NPD (past)

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

• Mission Hospital Regional Medical Center

  dba Providence Mission Hospital

  • General Acute Care Hospital
  • Mission Viejo, CA
  • NPI 1912108002
  Care Compare affiliation
• Mission Hospital Regional Medical Center

  dba Mission Hospital

  • General Acute Care Hospital
  • Mission Viejo, CA
  • NPI 1992752315
  Care Compare affiliation

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1265512982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 150",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918018",
            "telephone_number": "949-276-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 150",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918018",
            "telephone_number": "949-276-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "PHUONG",
        "middle_name": "CHI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C8448",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A53516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130542001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheila M Tedja Luwiharto, D.D.S.
• Luxottica of America Inc (LensCrafters #01321)
• Luxottica of America Inc. (Lenscrafters at Macy's #3248)
• LV Accesspoint Solutions
• LW Inc
• Lisa Lynch
• Lynn Napoli, M.D., Inc.
• M Atli DDS Inc (Globaldentalgroup Murat Atli)
• M J Fitzpatrick Incorporated
• M Jahromi Dentistry Professional Corporation (Honeycomb Dental)

• Family Medicine Physician in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.