Individual provider Active NPI

Lauren Audrey Licata, MD

  • Surgery Physician
  • Middletown, NY
National Provider Identifier
1023337763
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
278537 Issued in NY
Practice address
707 E Main St
Middletown, NY 10940-2650
Phone
(845) 333-7575
NPI assigned
May 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 255MA08698600 NJ
Surgical Critical Care Physician 2086S0102X 35123573 OH
Surgery Physician 208600000X 278537 NY Primary

Addresses

Primary practice location

707 E Main St
Middletown, NY 10940-2650

Mailing address

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-7575

Other practice location 1

68 Harris Bushville Rd
Harris, NY 12742
Phone (845) 333-8909

Other identifiers 2

IdentifierTypeStateIssuer
04182261MedicaidNY
0105408MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address llicata74847@direct.garnethealth.org Direct Garnet Health Doctors PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150930002364 NY Practitioner - General Surgery 8527284546 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
New York Medical College, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Garnet Health Doctors PCGroup PAC ID 8628293545, 165 clinicians

Practice addresses (Care Compare)

68 Harris Bushville Rd
Harris, NY 12742
Phone (845) 333-8909

Hospital & facility affiliations

  • Garnet Health Medical Center Hospital, Middletown, NY, CCN 330126
  • Garnet Health Medical Center Catskills Hospital, Harris, NY, CCN 330386

Merit-based Incentive Payment System (MIPS)

Final score
87.1 of 100Reported as group
Quality
61
Promoting interoperability
100
Improvement activities
40
Cost
72.76

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue92
Removal of skin lesions27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
255MA08698600NJMDSurgery Physician
35123573OHMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York Surgicalist Services, P.C. Surgery CurrentSince Mar 23, 2021 Accepting new patients
Garnet Health Doctors PC CurrentSince Nov 1, 2024 Accepting new patients
North Shore-Lij Medical PC CurrentSince Jul 12, 2015 Accepting new patients
Hudson Vista Medical,PC Surgery CurrentSince Jun 1, 2022 Accepting new patients
Garnet Health Doctors PC CurrentSince Nov 1, 2024 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery CurrentSince Mar 1, 2020 Accepting new patients
5 Pillars Billing, LLC Surgery PastSince Jul 11, 2018 Accepting new patients
Garnet Health Medical Center Past Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

19 Laurel Ave
Ste LL1
Cornwall, NY 12518
Phone (845) 534-7080

75 Crystal Run Rd
Ste 240
Middletown, NY 10941
Phone (845) 333-7700

707 E Main St
Middletown, NY 10940
Phone (845) 333-1000

460 Gidney Ave
Newburgh, NY 12550
Phone (845) 458-4700

70 Dubois St
Newburgh, NY 12550
Phone (845) 534-4673

407 Gidney Ave
Ste B
Newburgh, NY 12550
Phone (845) 458-4700

300 Community Dr
Plandome, NY 11030

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: llicata74847@direct.garnethealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1023337763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "68 Harris Bushville Rd",
            "address_purpose": "LOCATION",
            "city": "Harris",
            "state": "NY",
            "postal_code": "12742",
            "country_code": "US",
            "telephone_number": "845-333-8909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICATA",
        "first_name": "LAUREN",
        "middle_name": "AUDREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-20",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "255MA08698600",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "OH",
            "license": "35123573",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "278537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04182261",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105408",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "llicata74847@direct.garnethealth.org",
            "affiliation": "Y",
            "affiliationName": "Garnet Health Doctors PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "707 E Main St",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109402650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.