Lily Zhong, MD
Internal Medicine · San Jose
- Medicare standing
- Clear
- Enrolled, allowed to bill and order, not excluded
- Plans that list them
- 1
- 1 carrier
- Office
- 1
- Since medical school
- 12 years
- Oregon Health Sciences University School of Medicine, 2014
Offices
1 location · County of Santa Clara · 1,000 clinicians in this group
Looking this up.
Hospitals listed: Santa Clara Valley Medical Center. That is not proof they admit you there this week.
Plans that list them
1 plan · 1 carrier
A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Zhong’s office at (408) 885-5000 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | Anthem Blue Cross | Listed | Oct 3, 2026 |
California Medical Board record
Licence A140543 · Current
Licensed to practise in California · since 2016 · expires 2028-02-29 · Oregon Health & Science University School of Medicine.
No disciplinary actions, convictions, malpractice judgments or citations in this record.
Checkups this office reported
Medicare did not publish checkup rates for this clinician.
- Medicare’s overall office score
- 80.6 / 100
- Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.
Hospitals they work in
1 hospital
These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.
- Santa Clara Valley Medical CenterSan Jose, CAAcute Care Hospital · Government - Local · Has an emergency department · Birthing-friendlyPart of Santa Clara Valley Health and Hospital System, which runs 3 hospitalsPatients rate it 3 of 5 · 70% would definitely recommend itOverall rating: 2 of 5 starsWorse than the national rate — SSI - Colon Surgery: 2.572, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.563, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.256, Oct 2024 – Sep 2025Better than the national rate — MRSA Bacteremia: 0.369, Oct 2024 – Sep 2025
See every measure and the patient survey for Santa Clara Valley Medical Center
Behind the star rating — Deaths: 2 better, 6 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 1 worse of 8 measures. Readmissions: 0 better, 10 the same, 1 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| SSI - Colon SurgeryInfections | 2.572 | Worse | Oct 2024 – Sep 2025 |
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.563 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.256 | Better | Oct 2024 – Sep 2025 |
| MRSA BacteremiaInfections | 0.369 | Better | Oct 2024 – Sep 2025 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 1.25 (0.3 to 2.2) · 1,535 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 1.07 (0.76 to 1.38) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 214.59 (167.38 to 261.8) · 108 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 2.8 · 41 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 6 · 141 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 10.2 · 124 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 8.3 · 501 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 14.9 · 653 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 10.1 · 348 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 3 · 4,502 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.24 (0.04 to 0.43) · 9,014 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.34 (0.15 to 0.52) · 9,216 cases | No different | Jul 2022 – Jun 2024 |
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 4.54 (2.51 to 6.58) · 1,421 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 1.54 (0 to 3.2) · 288 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 2.11 (0.66 to 3.56) · 1,446 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative respiratory failure rateComplications and deaths | 11.61 (4.09 to 19.14) · 294 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative sepsis rateComplications and deaths | 7.29 (3.39 to 11.2) · 299 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 1.9 (0.45 to 3.36) · 333 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.23 (0 to 0.78) · 7,538 cases | No different | Jul 2022 – Jun 2024 |
| Rate of complications for hip/knee replacement patientsComplications and deaths | 5.4 · 94 cases | None | Apr 2023 – Mar 2025 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.735 | No different | Oct 2024 – Sep 2025 |
| SSI - Abdominal HysterectomyInfections | 2.573 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 14.6 · 185 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 22.1 · 951 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 56.3 · 128 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | 6.4 · 644 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 1.3 · 699 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 16.3 · 921 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 5.7 (3.9 to 8.1) · 226 cases | No different | Jan 2024 – Dec 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 12.6 (9.4 to 16.5) · 226 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission after hip/knee replacementUnplanned return visits | 5.4 · 94 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for CABGUnplanned return visits | 11.4 · 54 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 20.3 · 242 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 13.2 (9.9 to 17.4) · 702 cases | No different | Jan 2022 – Dec 2024 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 1 (0.7 to 1.4) · 195 cases | No different | Jan 2024 – Dec 2024 |
What patients said (4,032 patients answered, 29% of those asked)
| Cleanliness | 3 |
| Nurse communication | 3 |
| Doctor communication | 3 |
| Communication about medicines | 3 |
| Discharge information | 2 |
| Overall hospital rating | 3 |
| Quietness | 2 |
| Recommend hospital | 4 |
| Room was "always" clean | 70% |
| Nurses "always" communicated well | 73% |
| Doctors "always" communicated well | 76% |
| Staff "always" explained | 57% |
| Yes, staff "did" give patients this information | 82% |
| Yes, staff "did" give patients information about help after discharge | 82% |
| Doctors "always" explained things so they could understand | 71% |
| Doctors "always" listened carefully | 74% |
| Doctors "always" treated them with courtesy and respect | 82% |
| Patients who gave a rating of "9" or "10" (high) | 67% |
| Staff "always" explained new medications | 71% |
| Nurses "always" explained things so they could understand | 71% |
| Nurses "always" listened carefully | 69% |
| Nurses "always" treated them with courtesy and respect | 80% |
| "Always" quiet at night | 43% |
| "YES", patients would definitely recommend the hospital | 70% |
| Staff "always" explained possible side effects | 44% |
| Yes, staff "did" give patients information about possible symptoms | 83% |
Original Medicare doctor bills
$38,337
Medicare paid this office $38,337 for 130 people.
This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.
| Initial hospital care with moderate level of medical decision making at least 75 minutes | 80 | $12,198 | $149 |
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 69 | $9,787 | $69 |
| Subsequent hospital care with moderate levelof medical decision making at least 50 minutes | 43 | $8,539 | $107 |
| Hospital discharge day management, more than 30 minutes | 51 | $5,463 | $105 |
Who their Medicare patients are
130 Original Medicare patients in 2024. Average age 75 · Under 65 12% · 85 and older 24% · Women 45% · Also on Medicaid 79% · Health risk score 3.06. Sicker patients than 9 in 10 peers; the typical internal medicine clinician is at 1.76.
Conditions among them: High blood pressure 75% · Diabetes 52% · Heart failure 52% · Chronic kidney disease 49% · Coronary heart disease 47% · Atrial fibrillation 38% · Dementia 35% · Depression 30% · COPD 26% · Stroke 25% · Cancer 22%.
The office billed $411,489, Medicare allowed $49,045 and paid $38,337; for 384 services of 10 kinds.
Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.
Year by year
| 2024 | 130 | 384 | 75 | 3.06 | $411,489 | $38,337 |
| 2023 | 111 | 335 | 73 | 3.21 | $332,017 | $34,696 |
| 2022 | 128 | 376 | 73 | 3.05 | $356,350 | $41,784 |
| 2021 | 87 | 289 | 72 | 2.90 | $234,741 | $29,252 |
| 2020 | 118 | 409 | 70 | 3.64 | $313,166 | $37,570 |
| 2019 | 167 | 582 | 70 | 3.19 | $366,936 | $45,361 |
| 2018 | 61 | 214 | 73 | 2.49 | $98,170 | $16,590 |
Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.
See the services billed each year
2023: 4 services
| Subsequent hospital care with moderate levelof medical decision making at least 50 minutes | 54 | $11,052 | $112 |
| Initial hospital care with moderate level of medical decision making at least 75 minutes | 52 | $8,458 | $160 |
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 49 | $7,624 | $75 |
| Hospital discharge day management, more than 30 minutes | 52 | $5,730 | $108 |
2022: 6 services
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 60 | $12,374 | $78 |
| Initial hospital care with moderate level of medical decision making at least 75 minutes | 47 | $10,363 | $220 |
| Subsequent hospital care with moderate levelof medical decision making at least 50 minutes | 45 | $7,061 | $112 |
| Hospital discharge day management, more than 30 minutes | 40 | $4,841 | $118 |
| Initial hospital care with straightforward or low-level medical decision making at least 55 minutes | 12 | $1,766 | $147 |
| Hospital discharge day management, 30 minutes or less | 11 | $908 | $83 |
2021: 7 services
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 46 | $11,283 | $78 |
| Initial hospital care with moderate level of medical decision making at least 75 minutes | 21 | $4,625 | $220 |
| Hospital discharge day management, more than 30 minutes | 25 | $3,301 | $122 |
| Subsequent hospital care with moderate levelof medical decision making at least 50 minutes | 12 | $2,267 | $119 |
| Initial hospital care with straightforward or low-level medical decision making at least 55 minutes | 13 | $1,910 | $147 |
| Hospital discharge day management, 30 minutes or less | 14 | $1,172 | $84 |
| Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes | 14 | $778 | $41 |
2020: 8 services
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 81 | $16,219 | $74 |
| Initial hospital care with straightforward or low-level medical decision making at least 55 minutes | 38 | $5,053 | $133 |
| Hospital discharge day management, more than 30 minutes | 38 | $4,517 | $110 |
| Initial hospital care with moderate level of medical decision making at least 75 minutes | 18 | $3,940 | $207 |
| Subsequent hospital care with moderate levelof medical decision making at least 50 minutes | 18 | $2,155 | $108 |
| Hospital observation care on day of discharge | 15 | $1,170 | $78 |
| Hospital discharge day management, 30 minutes or less | 14 | $1,070 | $76 |
| Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes | 15 | $806 | $40 |
2019: 10 services
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 100 | $18,835 | $64 |
| Initial hospital care with straightforward or low-level medical decision making at least 55 minutes | 50 | $5,872 | $117 |
| Hospital discharge day management, more than 30 minutes | 53 | $5,179 | $98 |
| Initial hospital care with moderate level of medical decision making at least 75 minutes | 21 | $3,554 | $169 |
| Initial hospital observation care per day, typically 50 minutes | 30 | $3,503 | $109 |
| Hospital discharge day management, 30 minutes or less | 33 | $2,113 | $64 |
| Subsequent hospital care with moderate levelof medical decision making at least 50 minutes | 14 | $1,766 | $93 |
| Hospital observation care on day of discharge | 17 | $1,131 | $67 |
| Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes | 22 | $1,050 | $33 |
| Follow-up observation care per day, typically 25 minutes | 12 | $785 | $65 |
2018: 5 services
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 39 | $6,472 | $65 |
| Hospital discharge day management, more than 30 minutes | 19 | $1,975 | $99 |
| Initial hospital care with straightforward or low-level medical decision making at least 55 minutes | 15 | $1,833 | $122 |
| Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes | 13 | $909 | $35 |
| Hospital discharge day management, 30 minutes or less | 11 | $802 | $67 |
Medicaid work
$7,179 in 2024
Medicaid paid $7,179 for 552 billed services this clinician did in 2024, up to 21 people in a month for one service.
Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 230 | $2,619 |
| 1ST HOSP IP/OBS HIGH 75 | 133 | $2,406 |
| SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES | 97 | $1,079 |
| Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | 92 | $1,075 |
| 2024 | 552 | 4 | 21 | $7,179 |
| 2023 | 525 | 4 | 29 | $5,820 |
| 2022 | 433 | 3 | 20 | $5,862 |
| 2021 | 387 | 4 | 25 | $9,206 |
| 2020 | 292 | 2 | 21 | $4,420 |
| 2019 | 616 | 3 | 28 | $11,342 |
| 2018 | 188 | 2 | 17 | $2,928 |
See the largest Medicaid services in earlier years
2023
| 1ST HOSP IP/OBS HIGH 75 | 122 | $2,202 |
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 211 | $1,989 |
| Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | 78 | $867 |
| SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES | 114 | $761 |
2022
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 313 | $3,893 |
| SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES | 93 | $1,410 |
| 1ST HOSP IP/OBS HIGH 75 | 27 | $558 |
2021
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 313 | $6,876 |
| 1ST HOSP IP/OBS HIGH 75 | 30 | $1,032 |
| Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | 30 | $744 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | 14 | $553 |
2020
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 235 | $2,592 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | 57 | $1,828 |
2019
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 465 | $8,073 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | 101 | $2,370 |
| Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | 50 | $900 |
2018
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 130 | $1,756 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | 58 | $1,172 |
Drugs they prescribed that Part D paid
$27,325
Pharmacies billed $27,325 in 2024.
This is pharmacy cost, not the office bill, and not what patients paid.
168 generic and fewer than 11 brand-name prescriptions · $27,325 in drug cost · 25 antibiotic prescriptions to 20 people.
Part D prescriptions only. The opioid rate is opioid prescriptions as a share of all this clinician's Part D prescriptions; surgeons and pain specialists run higher than others, so it is shown against the same specialty.
| Eliquis | 11 | $10,642 | $967 |
| Levothyroxine | 16 | $167 | $10 |
Year by year
| 2024 | 228 | 77 | None | None | $27,325 |
| 2023 | 221 | 67 | None | None | $20,501 |
| 2022 | 162 | 53 | None | None | $20,729 |
| 2021 | 78 | 34 | 0% (0) | None | $4,970 |
| 2020 | 249 | 65 | None | None | $14,590 |
| 2019 | 247 | 72 | 0% (0) | None | $28,920 |
| 2018 | 180 | 55 | None | None | $12,459 |
| 2017 | 20 | None | 0% (0) | None | $2,061 |
Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.
See the drugs prescribed each year
2022: 1 drug
| Furosemide | 11 | $41 | $4 |
2020: 3 drugs
| Ventolin Hfa | 14 | $583 | $42 |
| Atorvastatin | 13 | $104 | $8 |
| Furosemide | 12 | $60 | $5 |
2019: 1 drug
| Atorvastatin | 23 | $185 | $8 |
2018: 1 drug
| Atorvastatin | 13 | $133 | $10 |
Professional record
- NPI
- 1851719736
- Licence
- CA A140543California A140543: Current · expires 2028-02-29
- Trained
- Oregon Health Sciences University School of Medicine, 2014 · 12 years ago
- Gender
- Female
More record details
- Sole proprietor
- No
- Taxonomy
- Internal medicine (207R00000X)
- Mailing address
- 751 S Bascom Ave, San Jose, CA, 95128
- NPI first listed
- 2014-03-28
- NPI last updated
- 2018-12-04
This is when the NPI record was last certified, not a medical board exam.