Margaret S. Licavoli
Individual provider Active NPI Gerontology Nurse Practitioner · Blairsville, GA
NPI 1487399416 · NPPES record last updated Aug 17, 2022
Key facts
- NPI
- 1487399416
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- RN168368 (GA)
- Practice address
- 123 Weaver Rd Ste B
Blairsville, GA 30512-3155 - Phone
- (170) 643-9648
- NPI assigned
- May 4, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sentinel Plastic Surgery LLC
Practice addresses (Care Compare)
123 Weaver Rd
Suite B
Blairsville, GA 30512-7703
Phone (706) 439-6486
Hospital & facility affiliations
- Hamilton Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.62 of 100
- Quality
- 85.24
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220902002295 | GA | Practitioner - Nurse Practitioner | 2365826765 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Life Chiropractic Center | Current |
Accepting new patients | |
| Sentinel Plastic Surgery LLC | Current |
Accepting new patients |
Locations
123 Weaver Rd
#B
Blairsville, GA 30512
Phone (706) 439-6486
351 E Highland St
Blue Ridge, GA 30513
Phone (706) 276-1099
Interoperability endpoints
- https://api.platform.athenahealth.com/16510/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | RN168368 | GA | Yes |
Addresses
Primary practice location
123 Weaver Rd Ste B
Blairsville, GA 30512-3155
Mailing address
351 E Highland St
Blue Ridge, GA 30513-4544
Other practice location 1
351 E Highland St
351 E Highland St
Blue Ridge, GA 30513-4544
Phone (706) 632-2707
Other providers in Blairsville, GA
- Molly Landry
- Robert Larsen
- Sven Lailer Legg-Grady
- Barry J Lewis
- Kassidy Lewis
- Life Wellness Center & Bookstore, L.L.C.
- Lifecare Medical Transport LLC
- Linda Ellis, Ma, LPC
- Linda Ellis, Ma, LPC, Inc
- Living Again Psychiatry LLC
All providers in Blairsville, GA · Gerontology Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.