Jeffrey Paul Licata, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

031134 Issued in NY

Practice address

3333 Hylan Blvd
Staten Island, NY 10306-3608

Phone

(718) 667-7500

NPI assigned

Mar 19, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, NY2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Barnabas Health Medical Group PCGroup PAC ID 9537316955, 1,027 clinicians

True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Medical Center Hospital, Toms River, NJ, CCN 310041

Merit-based Incentive Payment System (MIPS)

Final score

87.66 of 100Reported as group

Quality

73.72

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

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.

• True North Medical Group PC

  • Orthopaedic Surgery Physician
  • Merrick, NY
  • NPI 1659883486

  NJ

  Medicare reassignment Care Compare group NPD
• Barnabas Health Medical Group PC

  • Specialist
  • Elizabeth, NJ
  • NPI 1841557246
  Medicare reassignment Care Compare group
• National Health Rehabilitation LLC

  • Physical Medicine & Rehabilitation Physician
  • Edgewater, NJ
  • NPI 1780080218
  Medicare reassignment
• True North Medical Group PC

  • Oxygen Equipment & Supplies (DME)
  • Tarrytown, NY
  • NPI 1669272886
  NPD

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

• Community Medical Center Inc

  • General Acute Care Hospital
  • Toms River, NJ
  • NPI 1013010917
  Care Compare affiliation

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1104385947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063608",
            "telephone_number": "718-667-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Center Plz",
            "address_purpose": "LOCATION",
            "city": "Tinton Falls",
            "state": "NJ",
            "postal_code": "077249744",
            "country_code": "US",
            "telephone_number": "732-673-5131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICATA",
        "first_name": "JEFFREY",
        "middle_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-19",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00516300",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "031134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Liberovich, RN
• Robert John Liberto, P.A.
• Liberty Oral Surgery
• Brandon Liberzon, R.T.
• Serena Marie Licastro, L.MT
• Stephen Licata, P.T.
• Francine Licausi, RN
• Kandace R Licciardi, M.D.
• Bianca Licea
• Licensed Behavior Analyst L Bogdan PC

• Medical Physician Assistant in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.