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LYSHAWN XATIY PHOMMAKHOTH
NPI 1306627260
Physician Assistant in Sacramento, CA

Active since October 06, 2023PECOS Enrolled
8120 TIMBERLAKE WAY STE 108, SACRAMENTO, CA 95823(916) 252-5000 Get Directions Write a Review

NPPES record last updated: August 7, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 7, 2024, Jul 11, 2024, Oct 10, 2023 and 1 more (4 updates tracked since 2023).

About Lyshawn Xatiy Phommakhoth NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LYSHAWN XATIY PHOMMAKHOTH (NPI 1306627260) is an individual physician assistant in Sacramento, California, licensed in California (64438) and active in the NPI registry since October 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1306627260
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameLYSHAWN XATIY PHOMMAKHOTH
Location Address8120 TIMBERLAKE WAY STE 108Sacramento, CA 95823-5413
Mailing Address9534 Kelley DrStockton, CA 95209-1578 · (209) 487-3891
Phone(916) 252-5000
Sole ProprietorYes
Enumeration DateOctober 6, 2023
Last NPPES UpdateAugust 7, 20244 updates tracked since enumeration
NPPES CertifiedAugust 7, 2024
✔ NPI 1306627260 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · 64438
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
8120 TIMBERLAKE WAY STE 108, Sacramento, CA 95823
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lyshawn Xatiy Phommakhoth is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95823 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.61 typical visit price
range $60.44 – $180.85
Typical copayment $23.15 (range $15.11 – $45.21)
Most-billed visit code 99203
Established Patient
$75.03 typical visit price
range $19.88 – $148.15
Typical copayment $18.75 (range $4.97 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MALATHI SHANMUGAM MD
Family Medicine
8120 TIMBERLAKE WAY STE 108
SACRAMENTO, CA 95823
Sacramento County (916) 252-5000
SABAH ROHEEN KHAN PA
Physician Assistant
8120 TIMBERLAKE WAY STE 108
SACRAMENTO, CA 95823
Sacramento County (916) 252-5000
SAC CITY MD
Family Medicine
8120 TIMBERLAKE WAY STE 108
SACRAMENTO, CA 95823
Sacramento County (916) 252-5000

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 Lyshawn Phommakhoth's NPI number?

The NPI number for Lyshawn Phommakhoth is 1306627260. It was assigned to this individual provider in the NPPES registry on October 6, 2023.

Where is Lyshawn Phommakhoth located?

Lyshawn Phommakhoth practices at 8120 Timberlake Way Ste 108, Sacramento, CA 95823. The listed phone number is (916) 252-5000.

What is Lyshawn Phommakhoth's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Lyshawn Phommakhoth enrolled in Medicare?

Yes. Lyshawn Phommakhoth is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Lyshawn Phommakhoth was last updated on August 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.