Uyen T Ly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A76278 Issued in CA

Practice address

3802 Main Street
Occidental, CA 95465

Phone

(707) 874-2444

Fax

(707) 874-1664

NPI assigned

May 31, 2005

Last updated

Jan 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Washington School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Santa Rosa Community Health CentersGroup PAC ID 0345130423, 69 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: uly628044@direct.ochin.org

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Santa Rosa Community Health Centers

  dba Vista Campus

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1578631172
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Family Medicine

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Santa Rosa Community Health Centers

  dba Caritas Campus

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1467180430
  NPD
• Santa Rosa Community Health Centers

  dba Bridge Health Services

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1518345511
  NPD
• North Coast Faculty Medical Group Inc

  dba Sutter Medical Group of the Redwoods

  • Otolaryngology Physician
  • Sebastopol, CA
  • NPI 1750616512
  NPD (past)
• West County Health Centers, Inc.

  dba Occidental Area Health Center

  • Federally Qualified Health Center (FQHC)
  • Occidental, CA
  • NPI 1598768962
  NPD (past)
• West County Health Centers, Inc.

  dba Gravenstein South

  • Federally Qualified Health Center (FQHC)
  • Sebastopol, CA
  • NPI 1841916889
  NPD (past)

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1700889128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "954461449",
            "telephone_number": "707-874-2444",
            "fax_number": "707-874-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 MAIN STREET",
            "city": "OCCIDENTAL",
            "state": "CA",
            "postal_code": "95465",
            "telephone_number": "707-874-2444",
            "fax_number": "707-874-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "UYEN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-31",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A76278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03899G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "ZZZ23666Z",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "401 Bicentennial Way",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954032149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Dawson, PPS, LEP
• Dianna D, Evans, MFT
• Harmony Union School District
• Christopher Hensley, LMT, CMT, BCMTB
• Shari Liggett Kovner, RNFNP
• Elizabeth Medgyesy
• David Michael Medina
• Rain Moore, MD
• Leila Mori, MA
• Haeli Sierra Morris, CMT #95318

• Family Medicine Physician in Occidental, CA
• Providers in Occidental, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.