Richard Alfonso Licon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11666 Issued in CA

Practice address

1401 W 1St St Ste 101
Santa Ana, CA 92703-3757

Phone

(714) 542-9700

NPI assigned

Jan 23, 2009

Sex

Male

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

Specialty

Physician Assistant

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nellie Gail Urgent Care Medical CorpGroup PAC ID 7810203999, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: richard.liconpac.p1@direct.osiortho.nextgenshare.com

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.

• Nellie Gail Urgent Care Medical Corp

  • Urgent Care Clinic/Center
  • Laguna Hills, CA
  • NPI 1073909859
  Medicare reassignment Care Compare group
• Anaheim Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • Anaheim, CA
  • NPI 1962680033
  Medicare reassignment NPD
• South County Medical

  • Physician Assistant
  • Trabuco Canyon, CA
  • NPI 1467697276
  NPD Authorized official
• Proprius Health Medical Group PC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Long Beach, CA
  • NPI 1447515911
  Medicare reassignment
• Advance Urgent Medical Group Inc

  • Health Maintenance Organization
  • Santa Ana, CA
  • NPI 1881847424
  NPD
• Anaheim Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • Pasadena, CA
  • NPI 1467960914
  NPD
• Orange County Urgent Care #3, Inc.

  • Urgent Care Clinic/Center
  • Long Beach, CA
  • NPI 1619445111
  NPD
• Nellie Gail Urgent Care

  • Urgent Care Clinic/Center
  • Laguna Hills, CA
  • NPI 1306214184
  NPD (past)

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

{
    "created_epoch": "1232668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1740428101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 TECHNOLOGY DR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182302",
            "telephone_number": "949-923-3250",
            "fax_number": "855-812-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W 1ST ST STE 101",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927033757",
            "telephone_number": "714-542-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICON",
        "first_name": "RICHARD",
        "middle_name": "ALFONSO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-23",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Monica Huyentran Lieu, PA
• Life Generations Healthcare LLC
• Life Health Care Medical Group Inc
• Life Linc Habaco, Inc

• Physician Assistant in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.