NPIMap

Organization Active NPI

Safe Harbor Medical, Inc.

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1821290115
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
113458 Issued in NV
Legal business name
SAFE HARBOR MEDICAL, INC.
Practice address
2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404
Phone
(702) 870-8852
Fax
(702) 870-8914
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Ms. Tina A Alicea, MBA
Title
Ceo
Phone
(702) 870-8852

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 113458 NV Primary

Addresses

Primary practice location

2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404

Mailing address

2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404
Phone (702) 870-8852

Other identifiers 9

IdentifierTypeStateIssuer
250007806MedicaidNV
2019993MedicaidNV
NPIOtherNV1457320004
1104478270MedicaidNV
184105523MedicaidNV
1841205523MedicaidNV
100517352MedicaidNV
1619657996MedicaidNV
NPIOtherNV1932741048

Other names 1

  • SAFE HARBOR MEDICAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080925000222 NV Part B Supplier - Clinic/Group Practice 6204903792 Receives reassigned benefits from 10 practitioners
Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Safe Harbor Medical Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1821290115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281404",
            "telephone_number": "702-870-8852",
            "fax_number": "702-870-8914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281404",
            "telephone_number": "702-870-8852",
            "fax_number": "702-870-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2025-09-02",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "ALICEA",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-870-8852",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "113458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250007806",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2019993",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1457320004",
            "identifier": "NPI",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104478270",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184105523",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841205523",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100517352",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619657996",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1932741048",
            "identifier": "NPI",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFE HARBOR MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.