Meghan Licciardello, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1451 River Park Dr Ste 260
Sacramento, CA 95815-4504

Phone

(650) 826-2945

NPI assigned

Dec 12, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: mlicciardello@landmarkhealth-direct.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.

• Omar Osman Practice, LLC

  • Physical Medicine & Rehabilitation Physician
  • Morton Grove, IL
  • NPI 1669192472

  CA

  Medicare reassignment

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1689212482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HARDING BLVD STE 213",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956782474",
            "telephone_number": "916-390-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 RIVER PARK DR STE 260",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154504",
            "telephone_number": "650-826-2945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "427 Grove St",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956781508",
            "country_code": "US",
            "telephone_number": "916-390-1347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Harding Blvd Ste 213",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956782474",
            "country_code": "US",
            "telephone_number": "916-390-1347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICCIARDELLO",
        "first_name": "MEGHAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-12",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Jean Liberty-Vick, LMFT
• Dean Libet, MD
• Ralph A. Libet, MD
• Lidia Lica
• Christine Joy Licata
• Melissa L Lichte, MD
• Javier Lichui
• Jessica Anne Liddell, PSYD
• Brianna Lyndell Lide
• Prabhjyot Kaur Lidhar, DDS

• Physician Assistant in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.