Jordan Licata, DO is a medicare enrolled "Otolaryngology" physician in Tullahoma, Tennessee. He went to Philadelphia College Of Osteopathic Medicine and graduated in 2023 and has 3 years of diverse experience with area of expertise as Otolaryngology. He is a member of the group practice Marvel Clinic P.c. and his current practice location is
1821 N Washington St, Tullahoma, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(931) 461-5056.
Jordan Licata is licensed to practice in Tennessee (license number 5294) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1952795106.
Physician's Profile
| Full Name | Jordan Licata |
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| Gender | Male |
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| Speciality | Otolaryngology |
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| Experience | 3 Years |
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| Location | 1821 N Washington St, Tullahoma, Tennessee |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jordan Licata attended and graduated from Philadelphia College Of Osteopathic Medicine in 2023
NPI Data:
- NPI Number: 1952795106
- Provider Enumeration Date: 03/26/2015
- Last Update Date: 12/12/2024
Medicare PECOS Information:
- PECOS PAC ID: 1254788912
- Enrollment ID: I20231117000720
Medical Identifiers
Medical identifiers for Jordan Licata such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1952795106 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Y00000X | Otolaryngology | 05799 (Kentucky) | Secondary |
| 207Y00000X | Otolaryngology | 5294 (Tennessee) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Marvel Clinic P.c. | 0547454811 | 6 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jordan Licata allows following entities to bill medicare on his behalf.
| Entity Name | Marvel Clinic P.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1760487086
PECOS PAC ID: 0547454811
Enrollment ID: O20101101000063 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Licata is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jordan Licata, DO
1821 N Washington St,
Tullahoma, TN 37388-2221
Ph: (931) 461-5056 | Jordan Licata, DO
1821 N Washington St,
Tullahoma, TN 37388-2221
Ph: (931) 461-5056 |
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