DR. DERICK L LY D.O., M.S.
NPI 1962744417
Psychiatry & Neurology - Psychiatry in Ontario, CA

Q: What is Derick Ly's NPI number?

The NPI number for Derick Ly is 1962744417. It was assigned to this individual provider in the NPPES registry on March 22, 2013.

Q: What is Derick Ly's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Derick Ly was last updated on March 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.

Active since March 22, 2013PECOS EnrolledAccepts Medicare Assignment

2940 INLAND EMPIRE BLVD, ONTARIO, CA 91764(909) 458-1350 Get Directions Write a Review

NPPES record last updated: March 31, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 31, 2025, Jan 25, 2021 (2 updates tracked since 2021).

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About Dr. Derick L Ly D.o., M.s. NPPES

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

DR. DERICK L LY D.O., M.S. (NPI 1962744417) is an individual psychiatry provider in Ontario, California, licensed in California (13326) and active in the NPI registry since March 2013. He is enrolled in Medicare PECOS, maintains a secondary practice location in San Bernardino, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1962744417

Entity TypeIndividualMale

Primary Taxonomy2084P0800X

Provider Legal NameDR. DERICK L LYCredential: D.O., M.S.

Location Address2940 INLAND EMPIRE BLVDOntario, CA 91764-4898

Mailing Address303 E Vanderbilt WaySan Bernardino, CA 92415-0026 · (909) 252-5149

Phone(909) 458-1350

Sole ProprietorNo

Medical School CMSOtherGraduated 2012

Enumeration DateMarch 22, 2013

Last NPPES UpdateMarch 31, 20252 updates tracked since enumeration

NPPES CertifiedMarch 31, 2025

✔ NPI 1962744417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

License✔ Licensed in CA · 13326

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

2940 INLAND EMPIRE BLVD, Ontario, CA 91764

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Secondary Practice Location 1

Location 1303 E Vanderbilt WaySan Bernardino, CA 92415-0026 · Phone (909) 252-5149

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Derick L Ly D.o., M.s. 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.

PECOS PAC ID648558080

PECOS Enrollment IDI20161104001996

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 Derick Ly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

County Of San Bernardino

Same address

Clinic/Center

2940 INLAND EMPIRE BLVD
Ontario, CA 91764

Reassigned Medicare billing, California enrollment
233 clinicians in this Medicare group

NPI 1841407061 (909) 458-1350

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

32 services24 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91764 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

$179.42 typical visit price

range $59.60 – $179.42

Typical copayment $44.85 (range $14.90 – $44.85)

Most-billed visit code 99205

Established Patient

$74.08 typical visit price

range $19.37 – $146.42

Typical copayment $18.52 (range $4.84 – $36.60)

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 20

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

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