Lyshawn Xatiy Phommakhoth

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

64438 Issued in CA

Practice address

8120 Timberlake Way Ste 108
Sacramento, CA 95823-5413

Phone

(916) 252-5000

NPI assigned

Oct 6, 2023

Last updated

Aug 7, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: lphommakhoth223635@hpmg.direct-ci.net

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.

• Sac City MD

  • Family Medicine Physician
  • Sacramento, CA
  • NPI 1679180939
  Medicare reassignment

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1306627260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9534 KELLEY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952091578",
            "telephone_number": "209-487-3891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 TIMBERLAKE WAY STE 108",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958235413",
            "telephone_number": "916-252-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOMMAKHOTH",
        "first_name": "LYSHAWN",
        "middle_name": "XATIY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-06",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "64438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William L Phillips, MD
• Zoraya Phillips
• Jean Marie Philson
• Paul R. Phinney, MD
• Phoenix Home Health Sacramento LLC
• Brandon Choi Phong, MD
• Vanessa Phonhlamuongdy
• Malay Phoong, PHD
• Brian Phu
• Cindy Phun

• Physician Assistant in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.

Verify at the official NPI Registry.