NPIMap

Individual provider Active NPI

Tommy Leonard Hicks, M.D.

  • Family Medicine Physician
  • Laguna Hills, CA
National Provider Identifier
1760513758
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G48888 Issued in CA
Practice address
23521 Paseo de Valencia
Suite 108
Laguna Hills, CA 92653-3107
Phone
(949) 588-7262
Fax
(949) 588-7260
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G48888 CA Primary

Addresses

Primary practice location

23521 Paseo de Valencia
Suite 108
Laguna Hills, CA 92653-3107

Mailing address

23521 Paseo de Valencia
Suite 108
Laguna Hills, CA 92653-3107
Phone (949) 588-7262

Other identifiers 1

IdentifierTypeStateIssuer
G48888OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041026000219 CA Practitioner - Family PracticePractitioner - Geriatric Medicine 6507827276

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G48888CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Cohen D.O. C.M.D., Inc. Current Accepting new patients
Senior Care Medical Associates, Inc. CurrentSince Sep 7, 2007 Accepting new patients
Jorge a. Rivero, M.D., Inc. Current Accepting new patients
Homer Kam Yun Lew,D.O.,a Medical Corporation Current Accepting new patients
Nermine Morcos, M.D., Inc. Current Accepting new patients
Lori Clark M.D., Inc. Current Accepting new patients
Tommy L. Hicks, M.D., Inc. Family Medicine CurrentSince Sep 7, 2004 Accepting new patients
Wieler & Sein Medical Group Past Accepting new patients
Seasons of Life Hospice, LLC Family Medicine PastSince Feb 29, 2012 Accepting new patients

Locations

23521 Paseo de Valencia
Laguna Hills, CA 92653
Phone (949) 588-7262

23521 Paseo de Valencia
Ste 108
Laguna Hills, CA 92653
Phone (949) 396-1389

Interoperability endpoints

  • Direct secure messaging: tommy.hicks.1@11277.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Seasons of Life Hospice, LLCLake Forest, CA, CCN 551773 Hospice 5% Or Greater Direct Ownership Interest (14.29%) Feb 29, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196985600000",
    "number": "1760513758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23521 PASEO DE VALENCIA",
            "address_2": "SUITE 108",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533107",
            "telephone_number": "949-588-7262",
            "fax_number": "949-588-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23521 PASEO DE VALENCIA",
            "address_2": "SUITE 108",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533107",
            "telephone_number": "949-588-7262",
            "fax_number": "949-588-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "TOMMY",
        "middle_name": "LEONARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G48888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G48888",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

Verify at the official NPI Registry.