Individual provider Active NPI

Bao-Khuyen Nguyen Ly, PA-C

  • Medical Physician Assistant
  • Largo, FL
National Provider Identifier
1972149672
Registry record updated Apr 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9112468 Issued in FL
Practice address
13670 Walsingham Rd
Largo, FL 33774-3532
Phone
(727) 593-9848
NPI assigned
Nov 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9112468 FL Primary

Addresses

Primary practice location

13670 Walsingham Rd
Largo, FL 33774-3532

Mailing address

11921 N Dale Mabry Hwy
Tampa, FL 33618-3512
Phone (813) 609-3635

Other identifiers 1

IdentifierTypeStateIssuer
108286600MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BaoKhuyen.Nguyen@direct.mybaycare.org Health Information Exchange (HIE) BayCare Urgent Care, LLC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200212000524 FL Practitioner - Physician Assistant 6901232818 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Urgent Care, LLC.Group PAC ID 6103841051, 91 clinicians

Practice addresses (Care Compare)

1155 S Dale Mabry Hwy
Tampa, FL 33629-5035
Phone (813) 609-3666

13670 Walsingham Rd
Largo, FL 33774-3532
Phone (727) 593-9848

17512 Dona Michelle Dr
Tampa, FL 33647-3265
Phone (813) 533-3494

18610 Fernview St
Land O Lakes, FL 34638-6212
Phone (813) 692-8080

2331 4TH St N
St Petersburg, FL 33704-2801
Phone (727) 914-8566

2442 Bloomingdale Ave
Valrico, FL 33596-6403
Phone (813) 586-8686

3351 N McMullen Booth Rd
Clearwater, FL 33761-2014
Phone (727) 314-4774

3440 W Dr MLK Blvd
Suite 100
Tampa, FL 33607-6223
Phone (813) 559-1888

36245 Hwy 27
Haines City, FL 33844-3744
Phone (863) 866-9933

4821 US Hwy 19
Suite 5
New Port Richey, FL 34652-4259
Phone (727) 851-9650

Hospital & facility affiliations

  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075
  • Morton Plant Hospital Hospital, Clearwater, FL, CCN 100127

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9112468FLMDMedical Physician Assistant

Practice roles (3 of 5)

OrganizationSpecialtyStatusNew patients
Baycare Medical Group, Inc. CurrentSince Dec 1, 2020 Accepting new patients
Baycare Urgent Care, LLC CurrentSince Jul 14, 2020 Accepting new patients
Healthnow Urgent Care, L.L.C. PastSince Dec 1, 2019 Accepting new patients

Locations

2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234

2461 Enterprise Rd
Ste C
Clearwater, FL 33763
Phone (727) 725-5060

2995 Drew St
Fl 3
Clearwater, FL 33759

13670 Walsingham Rd
Largo, FL 33774
Phone (727) 593-9848

4821 US Highway 19
Ste 5
New Port Richey, FL 34652
Phone (727) 851-9650

6633 Forest Ave
Ste 105
New Prt Rchy, FL 34653
Phone (727) 845-4300

2331 4th St N
St Petersburg, FL 33704
Phone (727) 593-9848

11921 N Dale Mabry Hwy
Tampa, FL 33618
Phone (813) 609-3635

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 4

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 3

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": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681689600000",
    "number": "1972149672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11921 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336183512",
            "telephone_number": "813-609-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13670 WALSINGHAM RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337743532",
            "telephone_number": "727-593-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "BAO-KHUYEN",
        "middle_name": "NGUYEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-18",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9112468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108286600",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BaoKhuyen.Nguyen@direct.mybaycare.org",
            "affiliation": "Y",
            "affiliationName": "BayCare Urgent Care, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2995 Drew St Fl 2",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337593012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.