Jason Michael Licht, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-00069 Issued in NC

Practice address

3000 New Bern Ave
Suite 1200
Raleigh, NC 27610-1231

Phone

(919) 231-6132

Fax

(919) 231-6276

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jlicht7443@directhisp.wakemed.org

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.

• Wakemed Specialists Group, LLC

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1588227839
  Medicare reassignment Care Compare group
• Raleigh Cardiology Associates, PA

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1265488282
  NPD
• Wakemed Specialists Group LLC

  dba WakeMed - Virtual Cardiac Rehab

  • Cardiac Rehabilitation Registered Nurse
  • Raleigh, NC
  • NPI 1063304228
  NPD
• Wakemed Specialists Group, LLC

  • Pediatric Anesthesiology Physician
  • Raleigh, NC
  • NPI 1821653288
  NPD

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

• Wakemed

  dba WakeMed Mental Health & Well-Being Hospital WakeBrook

  • Psychiatric Hospital Unit
  • Raleigh, NC
  • NPI 1780446302
  Care Compare affiliation
• Wakemed

  dba WakeMed Raleigh Campus

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1972579837
  Care Compare affiliation

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1073533410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-0351",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "address_2": "SUITE 1200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-231-6132",
            "fax_number": "919-231-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHT",
        "first_name": "JASON",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-00069",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073533410",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlicht7443@directHISP.wakemed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "3000 New Bern Ave",
            "address_2": "Suite 1200",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276101231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Liberty Healthcare Group, LLC (Liberty Home Care)
• Liberty Home Health Care Inc
• Liberty Nursing Services, LLC (Liberty Nursing Service)
• Liberty Wellness Services
• Nicole Dora Licato, DNP, RN, FNP-BC
• Elizabeth Anne Lidiard, MHS, PA-C
• Amanda Lieberman Kenney, MSW, LCSW
• Kelly Lynn Liebermann, DPT
• Amanda Lieberum
• Gail Loretta Lieblang, NP

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.