NPIMap

Individual provider Active NPI

Ly Luu, M.D.

  • Clinical Pathology Physician
  • Salt Lake City, UT
National Provider Identifier
1689120909
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology PhysicianTaxonomy code 207ZC0006X
License
11291133-1205 Issued in UT
Practice address
15 N Medical Dr Ste 1100
Salt Lake City, UT 84112-1100
Phone
(801) 581-4390
NPI assigned
Aug 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 11291133-1205 UT
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 7691 NE
Clinical Pathology Physician 207ZC0006X 11291133-1205 UT Primary

Addresses

Primary practice location

15 N Medical Dr Ste 1100
Salt Lake City, UT 84112-1100

Mailing address

15 N Medical Dr Ste 1100
Salt Lake City, UT 84112-1100
Phone (801) 581-4390

Other practice location 1

601 N. 30th St - CU Department Of Pathology
Omaha, NE 68131
Phone (402) 717-0947

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201203001699 UT Practitioner - Pathology 0547671133 Reassigns benefits to 1 organization
I20220609002042 OK Practitioner - Pathology 0547671133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diagnostic Pathology Services, Inc.Group PAC ID 8224941547, 8 clinicians

Practice addresses (Care Compare)

4401 S Western Ave
Oklahoma City, OK 73109-3413
Phone (405) 636-7251

Hospital & facility affiliations

  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028
  • Integris Southwest Medical Center Hospital, Oklahoma City, OK, CCN 370106

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11291133-1205UTMDClinical Pathology Physician
7691NEMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Nov 30, 2020 Accepting new patients
Diagnostic Pathology Services, Inc. Anatomic Pathology & Clinical Pathology CurrentSince Jun 6, 2022 Accepting new patients
University of Utah Adult Services CurrentSince Nov 30, 2020 Accepting new patients
University of Utah Adult Services Current Accepting new patients
Choctaw Nation of Oklahoma Past Accepting new patients

Locations

2825 Parklawn Dr
Oklahoma City, OK 73110
Phone (405) 245-1453

4401 S Western Ave
Oklahoma City, OK 73109
Phone (405) 636-7000

14275 Midway Rd
Ste 400
Addison, TX 75001
Phone (214) 932-8018

1950 Circle of Hope Dr
Slc, UT 84112
Phone (801) 585-0100

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: lluu146220@direct.phhs.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1472342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1689120909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 N MEDICAL DR STE 1100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841121100",
            "telephone_number": "801-581-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 N MEDICAL DR STE 1100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841121100",
            "telephone_number": "801-581-4390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 N. 30th St - CU Department Of Pathology",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "68131",
            "country_code": "US",
            "telephone_number": "402-717-0947",
            "fax_number": "402-280-1237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUU",
        "first_name": "LY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-28",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "UT",
            "license": "11291133-1205",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NE",
            "license": "7691",
            "primary": false
        },
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "UT",
            "license": "11291133-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.