NPIMap

Individual provider Active NPI

Ly T Phan, MD

  • Surgery Physician
  • Columbia, MO
National Provider Identifier
1356430870
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2005030724 Issued in MO
Practice address
1601 E Broadway
Ste 240
Columbia, MO 65201-8020
Phone
(573) 815-8145
Fax
(573) 815-3832
NPI assigned
Oct 12, 2006
Last updated
Apr 11, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2005030724 MO Primary

Addresses

Primary practice location

1601 E Broadway
Ste 240
Columbia, MO 65201-8020

Mailing address

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141-8573
Phone (573) 815-8145

Other identifiers 1

IdentifierTypeStateIssuer
207505603MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20051109000014 MO Practitioner - General Surgery 0547288565 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1608 E Evergreen St
Suite a
Cameron, MO 64429-2400
Phone (816) 632-5424

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy32
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux38
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Scotland County Memorial Hospital Current Accepting new patients
Scotland County Memorial Hospital Surgery Current Accepting new patients
Missouri Delta Medical Center Surgery CurrentSince Aug 1, 2005 Accepting new patients
Harrison County Community Hospital District Current Accepting new patients
Scotland County Memorial Hospital CurrentSince Apr 13, 2021 Accepting new patients
Missouri Delta Medical Center CurrentSince Aug 1, 2005 Accepting new patients
Scotland County Memorial Hospital CurrentSince Apr 13, 2021 Accepting new patients
Poplar Bluff Hma Physician Management, LLC Surgery CurrentSince Oct 11, 2018 Accepting new patients
Cameron Regional Medical Center Inc CurrentSince Jun 1, 2019 Accepting new patients
Cameron Regional Medical Center, Inc. CurrentSince Jun 1, 2019 Accepting new patients
Cameron Regional Medical Center Inc Past Accepting new patients

Locations

2600 Miller St
Bethany, MO 64424
Phone (660) 425-2211

903 N 25th St
Bethany, MO 64424
Phone (660) 425-7333

1600 E Evergreen St
Cameron, MO 64429
Phone (816) 632-2101

1608 E Evergreen St
Ste A
Cameron, MO 64429
Phone (816) 632-3945

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

6000 Hospital Dr
#1257
Hannibal, MO 63401
Phone (573) 248-5460

450 E Sigler Ave
Memphis, MO 63555
Phone (660) 465-2828

450 E Sigler Ave
Ste A
Memphis, MO 63555
Phone (660) 465-2828

3098 Oak Grove Rd
Poplar Bluff, MO 63901
Phone (573) 778-2600

1008 N Main St
Sikeston, MO 63801
Phone (573) 471-1600

135 Plaza Dr
Ste 102
Sikeston, MO 63801
Phone (573) 264-2273

Interoperability endpoints

  • Direct secure messaging: lyphan@mhccaremail.com

Organizations & group practices 11

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 5

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1356430870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "573-815-8145",
            "fax_number": "573-815-3832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E BROADWAY",
            "address_2": "STE 240",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652018020",
            "telephone_number": "573-815-8145",
            "fax_number": "573-815-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "LY",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2005030724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207505603",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.