Jessica T Ly, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD26964 Issued in OR

Practice address

900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513

Phone

(360) 566-9355

Fax

(360) 816-1327

NPI assigned

Jun 4, 2006

Last updated

Nov 6, 2015By 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 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Pediatric MedicineAlso: Internal Medicine

Education

Loyola University of Chicago, Stritch School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Creekside Medical PSGroup PAC ID 4082683388, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150
• Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Creekside Medical, PS

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1760529374
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Legacy Salmon Creek Hospital

  dba Legacy Salmon Creek Providers

  • Clinic/Center
  • Vancouver, WA
  • NPI 1356357784

  Hospital

  Care Compare affiliation
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  Care Compare affiliation
• Peacehealth

  dba PeaceHealth SW Heart & Vascular Center

  • Cardiovascular Disease Physician
  • Vancouver, WA
  • NPI 1003194911

  Hospital

  Care Compare affiliation
• Peacehealth

  dba PeaceHealth Southwest Medical Center

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999
  Care Compare affiliation

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446768000000",
    "number": "1922047356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NE 139TH ST",
            "address_2": "SUITE 202",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852513",
            "telephone_number": "360-566-9355",
            "fax_number": "360-816-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NE 139TH ST",
            "address_2": "SUITE 202",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852513",
            "telephone_number": "360-566-9355",
            "fax_number": "360-816-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "JESSICA",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2015-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD26964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275535",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Huong The Luu, MD
• Luxottica of America Inc. (Lenscrafters #818)
• Luxottica Retail North America Inc (Sears Optical #0603)
• Samantha Nafula Lwali-Welsh
• Jennifer Ta Ly, DMD
• Thanh Ly
• Tiffany Ly
• Lydia Kay Lyall, RDA
• Yelena Lyashchina
• Shellie Marie Lyden, PT

• Internal Medicine Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2015; 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.