NPIMap

Individual provider Active NPI

Thai Ly, ARNP

  • Nurse Practitioner
  • Tacoma, WA
National Provider Identifier
1346902509
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP61225098 Issued in WA
Practice address
2302 S Union Ave Ste 30
Tacoma, WA 98405-1361
Phone
(253) 365-8074
NPI assigned
Oct 6, 2021
Last updated
Aug 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP61225098 WA Primary

Addresses

Primary practice location

2302 S Union Ave Ste 30
Tacoma, WA 98405-1361

Mailing address

2302 S Union Ave Ste 30
Tacoma, WA 98405-1361
Phone (253) 365-8074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221117003022 WA Practitioner - Nurse Practitioner 5698143949 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holistic Health and Beyond PLLCGroup PAC ID 6901260652, 3 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

2302 S Union Ave
Suite 30
Tacoma, WA 98405-1361
Phone (253) 365-8074

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61225098WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Holistic Health & Beyond PLLC CurrentSince May 1, 2023 Accepting new patients
Kalyan Dandala, MD PLLC CurrentSince Jul 1, 2023 Accepting new patients
Prudent Medical Providers NW Nurse Practitioner PastSince Sep 9, 2022 Accepting new patients

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1346902509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 S UNION AVE STE 30",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051361",
            "telephone_number": "253-365-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 S UNION AVE STE 30",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051361",
            "telephone_number": "253-365-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "THAI",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-06",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61225098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.