COLLEEN ANN LY PA-C
NPI 1184404261
Physician Assistant - Surgical in San Diego, CA
About Colleen Ann Ly Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COLLEEN ANN LY PA-C (NPI 1184404261) is an individual surgical provider in San Diego, California, licensed in California (PA63447) and active in the NPI registry since October 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Colleen Ann Ly Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Colleen Ly's NPI number?
The NPI number for Colleen Ly is 1184404261. It was assigned to this individual provider in the NPPES registry on October 5, 2023.
Where is Colleen Ly located?
Colleen Ly practices at 4060 Fourth Ave Ste 700, San Diego, CA 92103. The listed phone number is (619) 299-8500.
What is Colleen Ly's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.
Is Colleen Ly enrolled in Medicare?
Yes. Colleen Ly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Colleen Ly was last updated on April 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Colleen Ann Ly, PA-C · NPI 1184404261
Surgical physician in San Diego, California. Individual provider, active in the CMS NPPES registry since October 5, 2023.
## Identity
- **NPI:** 1184404261 (Entity type: Individual)
- **Enumerated:** October 5, 2023
- **Primary specialty:** Physician Assistant - Surgical · taxonomy 363AS0400X
- **State license:** PA63447 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4060 FOURTH AVE STE 700, San Diego, CA 92103-2121
- **Phone:** (619) 299-8500
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** April 24, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1184404261) · Data from the CMS NPPES public registry.