Thomas C Ly, MD
Individual provider Active NPI Family Medicine Physician · Lake Havasu City, AZ
NPI 1891007787 · NPPES record last updated Jan 18, 2012
Key facts
- NPI
- 1891007787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 45537 (AZ)
- Practice address
- 101 Civic Center LN
Lake Havasu City, AZ 86403-5607 - Phone
- (928) 854-0002
- Fax
- (928) 453-0885
- NPI assigned
- Jul 8, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Apogee Medical Group Inc
La Paz Regional Hospital Inc
Practice addresses (Care Compare)
101 Civic Ctr LN
Lake Havasu City, AZ 86403-5607
Phone (928) 855-8185
1200 W Mohave Rd
Parker, AZ 85344-6349
Phone (928) 669-7382
1713 S Kofa Ave
Suite a
Parker, AZ 85344-6401
Phone (928) 669-7380
Hospital & facility affiliations
- Havasu Regional Medical Center
- La Paz Regional Hospital
- Kingman Regional Medical Center
- La Paz Regional Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 99.61 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 88.22
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111227000084 | AZ | Practitioner - Hospitalist |
8224204110 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Hospitalist Services of Arizona, LLC | Current |
Accepting new patients | |
| La Paz Regional Hospital, Inc. | Current |
Accepting new patients | |
| Apogee Medical Group Inc | Current |
Accepting new patients | |
| Apogee Medical Group Inc | Current |
Accepting new patients | |
| La Paz Regional Hospital Inc | Current | Accepting new patients | |
| Comprehensive Hospitalist Services of Arizona LLC | Current |
Accepting new patients | |
| La Paz Regional Hospital Inc | Current |
Accepting new patients | |
| Polaris Medical Group LLC | Past | Accepting new patients | |
| Havasu Regional Medical Center LLC | Past | Accepting new patients |
Locations
101 Civic Center Ln
Lk Havasu Cty, AZ 86403
Phone (928) 453-0150
1301 S Crismon Rd
Mesa, AZ 85209
Phone (480) 358-6300
1713 S Kofa Ave
Ste A
Parker, AZ 85344
Phone (928) 669-7380
1200 W Mohave Rd
Parker, AZ 85344
Phone (928) 669-7300
807 S Ponderosa St
Payson, AZ 85541
Phone (520) 474-3222
Interoperability endpoints
- thomasly@lprh.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 45537 | AZ | Yes |
Addresses
Primary practice location
101 Civic Center LN
Lake Havasu City, AZ 86403-5607
Mailing address
13236 N 7TH St
Ste 4- 255
Phoenix, AZ 85022-5343
Phone (928) 854-0002
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 666099 | Medicaid | AZ |
Other providers in Lake Havasu City, AZ
- Luana Kay Luna
- Lundin Dental PC
- Cameron Lundin
- Larry C Lundin
- Paula R Lupo
- Jennifer Macdonald
- George Macey
- Nicole Mackey
- Shannon Donnel Macklem
- Made 4 Movement PLLC
All providers in Lake Havasu City, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.