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VAN THANH LY FNP-C
NPI 1790426781
Nurse Practitioner - Family in San Jose, CA

Active since April 05, 2022PECOS Enrolled
200 JOSE FIGUERES AVE STE 180, SAN JOSE, CA 95116(408) 876-0836 Get Directions Write a Review

NPPES record last updated: September 6, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 6, 2022, Apr 5, 2022 (2 updates tracked since 2022).

About Van Thanh Ly Fnp-c NPPES

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

VAN THANH LY FNP-C (NPI 1790426781) is an individual family provider in San Jose, California, licensed in California (95020564) and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1790426781
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameVAN THANH LYCredential: FNP-C
Location Address200 JOSE FIGUERES AVE STE 180San Jose, CA 95116-1586
Mailing Address8721 Church StGilroy, CA 95020-4233 · (408) 876-0836
Phone(408) 876-0836
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 5, 2022
Last NPPES UpdateSeptember 6, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 6, 2022
✔ NPI 1790426781 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 95020564
200 JOSE FIGUERES AVE STE 180, San Jose, CA 95116
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Van Thanh Ly Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4688196678
PECOS Enrollment IDI20260220001325
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.

Medicare Billing Reassignment

Medicare enrollment records show Van Ly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Professional Wound Specialists PC
322 mi
Surgery
3191 W TEMPLE AVE STE 110
Pomona, CA 91768
  • Reassigned Medicare billing, California enrollment
  • 31 clinicians in this Medicare group
NPI 1437988326 (888) 434-8880

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95116 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
$106.47 typical visit price
range $70.37 – $206.04
Typical copayment $26.61 (range $17.59 – $51.51)
Most-billed visit code 99203
Established Patient
$121.77 typical visit price
range $23.96 – $169.60
Typical copayment $30.44 (range $5.99 – $42.40)
Most-billed visit code 99214
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 5

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

BAY AREA HOSPITAL PHYSICIAN
Internal Medicine
200 JOSE FIGUERES AVE STE 180
SAN JOSE, CA 95116
Santa Clara County (408) 258-5083
SILICON VALLEY INTERNIST GROUP, INC
Internal Medicine
200 JOSE FIGUERES AVE STE 180
SAN JOSE, CA 95116
Santa Clara County (408) 258-5083
JENNY DACI YANG, PC
Internal Medicine (Gastroenterology)
200 JOSE FIGUERES AVE STE 180
SAN JOSE, CA 95116
Santa Clara County (408) 740-3353
MD24 SJ, INC.
Family Medicine
200 JOSE FIGUERES AVE STE 180
SAN JOSE, CA 95116
Santa Clara County (623) 374-7774
DR. TAM HOANG NGUYEN D.O.
Internal Medicine
200 JOSE FIGUERES AVE STE 180
SAN JOSE, CA 95116
Santa Clara County (408) 258-5083

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 Van Ly's NPI number?

The NPI number for Van Ly is 1790426781. It was assigned to this individual provider in the NPPES registry on April 5, 2022.

Where is Van Ly located?

Van Ly practices at 200 Jose Figueres Ave Ste 180, San Jose, CA 95116. The listed phone number is (408) 876-0836.

What is Van Ly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Van Ly enrolled in Medicare?

Yes. Van Ly is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Van Ly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Van Ly reassigns Medicare benefits to Professional Wound Specialists PC (Pomona, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Van Ly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Van Ly was last updated on September 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.