Albert Jackson Lilly III, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD22604 Issued in OR

Practice address

61250 SE Coombs PL
Bend, OR 97702-3704

Phone

(541) 706-5930

Fax

(541) 706-5931

NPI assigned

Jun 13, 2006

Last updated

Apr 17, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Emergency Medicine

Education

Eastern Virginia Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047
• St Charles Medical Center Prineville Hospital, Prineville, OR, CCN 381313

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Charles Health System, Inc.

  dba St. Charles Medical Group

  • Family Medicine Physician
  • Bend, OR
  • NPI 1023331303
  Medicare reassignment Care Compare group NPD
• St. Charles Health System, Inc.

  dba St. Charles Bend

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447

  Emergency Medicine

  Medicare reassignment NPD
• St. Charles Health System, Inc.

  dba St. Charles Medical Center - Bend

  • Rehabilitation Hospital Unit
  • Bend, OR
  • NPI 1154343150
  NPD
• St. Charles Health System, Inc.

  dba The Center at St. Charles Medical Equipment

  • Specialist
  • Bend, OR
  • NPI 1700697935
  NPD
• St. Charles Health System, Inc.

  dba St. Charles Behavioral Health

  • Clinical Social Worker
  • Bend, OR
  • NPI 1780698696
  NPD
• Peony Emergency Physicians

  • Emergency Medicine Physician
  • Charlestown, IN
  • NPI 1154470052
  NPD (past)

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

• Cascade Healthcare Community Inc

  dba NW High Desert Sleep Center Bend

  • Sleep Disorder Diagnostic Clinic/Center
  • Bend, OR
  • NPI 1164675963

  Hospital

  Care Compare affiliation
• St. Charles Health System, Inc.

  dba St. Charles Prineville

  • Critical Access Hospital
  • Prineville, OR
  • NPI 1710160445
  Care Compare affiliation
• St. Charles Health System, Inc.

  dba St. Charles Bend

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Care Compare affiliation

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1285677955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5579",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977085579",
            "telephone_number": "541-706-3700",
            "fax_number": "541-706-3730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61250 SE COOMBS PL",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023704",
            "telephone_number": "541-706-5930",
            "fax_number": "541-706-5931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "ALBERT",
        "middle_name": "JACKSON",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD22604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "958936",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alilly17775@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "61250 SE Coombs Pl",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977023704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lifestyle Medicine of Central Oregon, PC
• Lifetime Vision Care
• Lifetime Vision Care LLC
• McKenzie L Lighty, LMT
• Matthew Raymond Lilley, MD
• Allegra Danielle Anderson Lilly, CPM, LDM
• Soma I Lilly, M.D.
• Tiffany Lim
• Charlotte Lin, MD
• Natalie Lin, LMFT

• Emergency Medicine Physician in Bend, OR
• Providers in Bend, OR by specialty
• Emergency Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.