Ivan Alexis Licea Tamayo, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

L3510R Issued in AL

Practice address

4371 Narrow Lane Rd
Montgomery, AL 36116-2971

Phone

(334) 613-3680

NPI assigned

Jan 31, 2014

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 FL

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

Specialty

Family Practice

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leon Medical Centers LLCGroup PAC ID 9537066618, 108 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
• Moments Hospice of Miami LLC Hospice, Miami Lakes, FL, CCN 101566

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Leon Medical Centers LLC

  • Health Service Clinic/Center
  • Miami, FL
  • NPI 1376579839
  Medicare reassignment Care Compare group NPD
• The Health Care Authority for Baptist Health

  • Clinic/Center
  • Montgomery, AL
  • NPI 1538347067
  NPD (past)

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

• Moments Hospice of Miami LLC

  • Community Based Hospice Care Agency
  • Miami Lakes, FL
  • NPI 1407527849
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Boynton Beach, FL
  • NPI 1467507657
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Miami Lakes, FL
  • NPI 1528113792
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Melbourne, FL
  • NPI 1669548053
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Tallahassee, FL
  • NPI 1972555464
  Care Compare affiliation

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

{
    "created_epoch": "1391126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391126400000",
    "number": "1669895223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4371 NARROW LANE RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162971",
            "telephone_number": "334-613-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4371 NARROW LANE RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162971",
            "telephone_number": "334-613-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICEA TAMAYO",
        "first_name": "IVAN",
        "middle_name": "ALEXIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-31",
        "last_updated": "2014-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 118521",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "L3510R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meleisa Yvonne Lewis
• Sade Nicole Lewis
• Shamaya Lewis, RBT
• Shaquaina Janae Lewis, RBT
• Stephanee Rhea Lewis, DC
• David Michael Lieux, D.D.S.
• William Edward Lievens, M.D.
• Life Time Resolutions
• Lifeline by B&V LLC
• Lifeline Harbor LLC

• Family Medicine Physician in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; 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.