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ALYSSA LY DDS
NPI 1811678204
Dentist - General Practice in Saint Louis, MO

Active since July 27, 2023PECOS Enrolled
4352 MANCHESTER AVE, SAINT LOUIS, MO 63110(314) 371-0336 Get Directions Write a Review

NPPES record last updated: September 10, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Sep 10, 2023, Aug 7, 2023, Jul 27, 2023 (3 updates tracked since 2023).

About Alyssa Ly Dds NPPES

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

ALYSSA LY DDS (NPI 1811678204) is an individual general practice provider in Saint Louis, Missouri, licensed in Missouri (2023025120) and active in the NPI registry since July 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1811678204
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameALYSSA LYCredential: DDS
Location Address4352 MANCHESTER AVESaint Louis, MO 63110-2138
Mailing Address401 Holly Hills AveSaint Louis, MO 63111-2410 · (314) 353-5190
Phone(314) 371-0336
Sole ProprietorNo
Enumeration DateJuly 27, 2023
Last NPPES UpdateSeptember 10, 20233 updates tracked since enumeration
NPPES CertifiedAugust 26, 2023
✔ NPI 1811678204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MO · 2023025120
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
4352 MANCHESTER AVE, Saint Louis, MO 63110
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Alyssa Ly Dds 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.

Medicare Billing Reassignment

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

Family Care Health Centers
4.8 mi
Federally Qualified Health Center (FQHC)
401 HOLLY HILLS AVE
Saint Louis, MO 63111
  • Reassigned Medicare billing, Missouri enrollment
  • 55 clinicians in this Medicare group
NPI 1508867508 (314) 481-1615

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 63110 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
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
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 19

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

FAMILY CARE HEALTH CENTERS
Clinic/Center (Federally Qualified Health Center (FQHC))
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 481-1616
COLEEN R. JONES WHNP-BC
Nurse Practitioner
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444
DR. JAIME ZENGOTITA MD
Family Medicine
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444
VICKI SWYERS LCSW
Social Worker (Clinical)
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444
RICHARD GERALD BOLANOS JR. M.D.
Obstetrics & Gynecology
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444
DR. HARRY RICHARD SCHARF DENTIST
Dentist
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444
VALERIE LATRICE JOHNSON WHNP-BC
Nurse Practitioner (Women's Health)
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444
DR. TARA MARIE BUDETTI M.D.
Pediatrics
4352 MANCHESTER AVE
SAINT LOUIS, MO 63110
St. Louis City (314) 531-5444

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 Alyssa Ly's NPI number?

The NPI number for Alyssa Ly is 1811678204. It was assigned to this individual provider in the NPPES registry on July 27, 2023.

Where is Alyssa Ly located?

Alyssa Ly practices at 4352 Manchester Ave, Saint Louis, MO 63110. The listed phone number is (314) 371-0336.

What is Alyssa Ly's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Alyssa Ly enrolled in Medicare?

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

Which organization bills Medicare for Alyssa Ly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Alyssa Ly reassigns Medicare benefits to Family Care Health Centers (Saint Louis, MO). 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 Alyssa Ly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Alyssa Ly accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter of Oklahoma and Ambetter of Tennessee and 5 other insurers list Alyssa Ly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Alyssa Ly was last updated on September 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.