Phuong Ly

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9116750 Issued in FL

Practice address

1717 S Orange Ave Ste 103
Orlando, FL 32806-2946

Phone

(321) 841-3444

Fax

(321) 843-1753

NPI assigned

Jan 4, 2021

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Orlando Health Hospital, Orlando, FL, CCN 100006
• Orlando Health South Lake Hospital Hospital, Clermont, FL, CCN 100051
• Orlando Health-Health Central Hospital Hospital, Ocoee, FL, CCN 100030

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Orlando Health Medical Group Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1669429577
  Medicare reassignment Care Compare group NPD
• Vitalmd Group Holding LLC

  • Obstetrics & Gynecology Physician
  • Miami, FL
  • NPI 1871572032
  Medicare reassignment

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

• Orlando Health Central, Inc.

  • General Acute Care Hospital
  • Ocoee, FL
  • NPI 1033475959
  Care Compare affiliation
• Orlando Health Central, Inc.

  • Urgent Care Clinic/Center
  • Ocoee, FL
  • NPI 1780022616

  Hospital

  Care Compare affiliation
• Orlando Health, Inc.

  • General Acute Care Hospital
  • Orlando, FL
  • NPI 1184709057
  Care Compare affiliation
• South Lake Hospital, Inc.

  • General Acute Care Hospital
  • Clermont, FL
  • NPI 1336221019
  Care Compare affiliation

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1922696129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE STE 103",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062946",
            "telephone_number": "321-841-3444",
            "fax_number": "321-843-1753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE STE 103",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062946",
            "telephone_number": "321-841-3444",
            "fax_number": "321-843-1753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1507 S Hiawassee Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328355706",
            "country_code": "US",
            "telephone_number": "407-601-5308",
            "fax_number": "407-482-8698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LY",
        "first_name": "PHUONG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116898800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc
• Jessica Luzincourt, BSW, CNP
• LW Peds PT, LLC
• Khine Su Lwin, M.D.
• Jacklyn Ly, OD
• Kelsea Lydon, PA-C
• Lyfe Changes LLC
• Morgan Leeann Lyles, DNAP
• Kacy D Lyman, CRNA
• Nicole Lyman

• Physician Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.