NPIMap

Individual provider Active NPI

Calvin C. Ly, DO

  • Emergency Medicine Physician
  • Hercules, CA
National Provider Identifier
1376761767
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20A 10209 Issued in CA
Practice address
600 Alfred Nobel Dr Ste a
Hercules, CA 94547-1834
Phone
(510) 984-1103
NPI assigned
Apr 23, 2007
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 58001776 OH
Emergency Medicine Physician 207P00000X 20A 10209 CA Primary

Addresses

Primary practice location

600 Alfred Nobel Dr Ste a
Hercules, CA 94547-1834

Mailing address

250 Point Lobos Ave Apt 603
San Francisco, CA 94121-1402
Phone (714) 883-8261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20081021000376 CA Practitioner - Emergency Medicine 7517025562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SNF Specialists Medical CorporationGroup PAC ID 3678849049, 26 clinicians

Practice addresses (Care Compare)

1255 Travis Blvd
Fairfield, CA 94533-4801
Phone (800) 973-1540

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.82 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
79.4

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A 10209CAMDEmergency Medicine Physician
58001776OHMDEmergency Medicine Physician
42495CAMDGeriatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
SNF Specialists Medical Corporation CurrentSince Jun 15, 2021 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America-California Emergency Medicine CurrentSince Aug 1, 2014 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Aug 1, 2014 Accepting new patients

Locations

1255 Travis Blvd
Fairfield, CA 94533
Phone (707) 425-0623

12601 Garden Grove Blvd
Garden Grove, CA 92843
Phone (714) 537-5160

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Interoperability endpoints

  • Direct secure messaging: calvin.ly@49412312072196.direct.elationemr.com

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 6

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": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1376761767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 POINT LOBOS AVE APT 603",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941211402",
            "telephone_number": "714-883-8261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ALFRED NOBEL DR STE A",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471834",
            "telephone_number": "510-984-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "CALVIN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "58001776",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A 10209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hercules, CA

Sources for this page

Verify at the official NPI Registry.